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Reference  Library 

Given  by 


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LECTURES  DELIVERED 

AT  THE  ST.   LOUIS  HOSPITAL,  PARIS. 


BY 


ALFRED    FOURNIEE, 

rEOFESSEUB  A   LA   FACDXTE   DE   MEDEOINE  DE   PARIS,   MEDECIN  DB  I'ilOPITAI.   ST.-LOUIE', 
MEMBKE   DE   L'ACADEAIIE  DE  MEDECIME. 


teajS'slated  by 
p.    ALBERT    MORKOW,    M.D., 

PHYSICIAN    TO   THE    SKIN    AND   VENEEEAL    DEPAETMENT,   KEW   TOES  DISPENSAZT 

MEMBEE   OF  THE  NEW  YOEK    DEEMATOLOSICAL   SOCIETi'  ;    MEMEEE  OP 

THE   NEW   YOEK  ACADEMY   OF   MEDICINE. 


NEW    YORK : 
D.  APPLETON    AND    COMPANY, 

1.   3,   AND   5   BOND   8TEEET. 
1882, 


OOPTKIGHT   B7 

D.   APPLETON    AND    COMPANY, 

18S0. 


TEAJSrSLATOR'S   PEEFAOE. 


The  mere  announcement  of  the  title  of  this  book  is  a 
sufficient  apology,  if  any  were  needed,  for  bringing  it 
before  the  medical  profession  of  this  country. 

There  is  not,  that  I  am  aware,  any  work  in  the  English 
language  which  treats  of  the  relations  of  syphilis  with 
marriage.  This  important  subject  has  been  entirely  ig- 
nored, or  only  incidentally  alluded  to,  in  a  majority  of 
our  standard  text-books  on  Venereal. 

Reference  has  been  made  to  it  in  a  few  special  works 
and  monographs  not  accessible  to  the  general  practi- 
tioner, but  nowhere  has  it  been  exhaustively  studied,  and 
the  practical  questions,  medical  and  social,  growing  out 
of  it,  been  discussed  in  a  thoroughly  systematic  and  com- 
prehensive manner. 

And  yet,  it  will  be  generally  conceded,  there  is  scarcely 
a  subject  in  the  entire  domain  of  medicine  of  greater  prac- 
tical importance  to  the  profession  and  to  the  public,  not 
only  on  account  of  the  nature  of  the  pathological  ques- 


iv  TRANSLATOR'S  PREFACE. 

tions  presented,  but  also  on  account  of  the  family  and 
society  interests  involved,  and  wliich  it  is  tlie  physi- 
cian's  manifest  duty  to  protect.  In  considering  tlie  social 
aspects  of  the  question,  the  author  gives  special  promi- 
nence to  the  moral  obligation  imposed  upon  the  physician 
as  regards  public  prophylaxis,  and  formulates  a  complete 
system  of  rules  to  guide  his  conduct  in  dealing  with  the 
various  complex  and  difficult  social  problems  which  may 
arise. 

As  intimated  above,  I  was  led  to  prepare  a  translation 
of  this  work  because  it  supplies  a  v>^ant  long  recognized 
in  medical  literature,  and  because  the  reputation  of  M. 
Fournier  as  a  universally  acknowledged  authority  upon 
the  subjects  of  Avhich  he  treats  is  a  sufficient  guarantee  of 
its  excellence  and  scientific  value.  To  specialists  in  this 
department,  and  others  familiar  with  the  advances  made 
in  sypMlography  during  the  last  twenty  years.  Professor 
Foumier  needs  no  introduction.  His  long  connection 
with  the  Lourcine,  the  St.  Louis,  and  other  special  hospi- 
tals of  Paris,  has  placed  at  his  disposition  rich  stores 
of  clinical  experience,  which  his  rare  discrimination  and 
practiced  powers  of  analysis  have  enabled  him  to  utilize 
to  the  best  advantage.  His  numerous  contributions  to 
the  study  of  Syphilis,  notably  among  which  may  be  men- 
tioned his  studies  of  syphilis  of  the  brain  and  the  spinal 
cord,  are  all  stamped  with  originality  and  great  clinical 


TRANSLATOR'S  PREFACE.  v 

judgment,  and  rank  among  the  most  valuable  acquisitions 
of  contemporaneous  medical  science.  Quite  recently,  a 
special  chair  lias  been  created  for  Mm  in  the  Faculty  of 
Medicine  of  Paris — an  unusual  distinction,  and  one  which 
shows  the  high  estimation  in  which  his  talents  and  work 
are  regarded. 

The  present  work  exhibits  a  profound  knowledge  of 
the  subject  in  all  its  relations,  united  v/ith  a  rare  skill  and 
tact  in  treating  the  delicate  social  questions  necessarily 
involved  in  such  a  line  of  investigation. 

The  very  full  synoptical  table  of  contents  which  pref- 
aces this  work  renders  an  index  unnecessary,  and  I  have 
thought  best  to  dispense  with  it. 

New  Yoek,  October  1,  1880. 


OOJSTTEIN^TS. 


PAGE 
luTKODUCTIOK  ..........         1 

PART    I, 

BEFOUE     MAREIAGE. 

CHAPTEE    I. 

PRELIMINARY  QUESTIONS. 

Importance  of  the  Subject — How  the  Question  of  the  Marriage  of  Syphilitics  pre- 
sents itself  to  the  Physician  in  Practice — Grave  Eesponsibility  incurred  by 
the  Physician — Deplorable  Results  of  an  Error  committed  under  such  Cir- 
cumstances— Precise  Eole  of  the  Physician  consulted  upon  the  Subject — Two 
very  Different  Classes  of  Consultants — Absolute  Necessity  for  the  Physician 
to  judge  the  Question  from  an  exclusively  Medical  Point  of  View,  without 
allowing  himself  to  be  influenced  by  extraneous  Considerations — Prelimi- 
nary Question — Does  Syphilis  constitute  an  Express  Interdiction,  an  Absolute 
Obstacle  to  Marriage? — Diverse  Opinions — Appeal  to  Observation — Save  very 
Bare  Exceptions,  Sjrpbilis  constitutes  only  a  Temporary  Interdiction  to 
Marriage        ..........     15 

CHAPTEE   IT. 

DANGERS  DUE  TO  SYPHILIS  IN  MARRIAGE— DIRECT  CONTAGION. 

Dangers  introduced  by  Syphilis  into  Marriage — Three  Orders  of  Dangers — Divi- 
sion of  the  Subject — Dangers  relative  to  the  Wife — Frequency  of  Syphilis 
among  the  Young  Married — Statistics — First  Order  of  Contamination  possible 
for  the  Wife — Direct  Contagion,  or  Transmission  to  the  Wife  of  Contagious 
Accidents  happening  to  the  Husband  after  Marriage — Clinical  Examples         .     21 

CHAPTEE   III. 

SYPHILIS  BY  CONCEPTION. 

Second  Order  of  Contamination  possible  for  the  Wife — Syphilis  by  Conception — 
How  Cases  of  Syphilis,  originating  in  this  Special  Manner,  present  them- 
selves in  Practice — Their  Undeniable  Authenticity — Their  Frequency — Their 


viii  CONTENTS. 

PAOR 

Apparent  Deviation  from  tlie  General  Laws  of  Syphilitic  Infection  explained 
by  the  Intervention  of  a  Special  Element,  Pregnancy — Syphilis  by  Concep- 
tion, the  Analof:fue  of  the  Syphilis  v/hich  in  the  Course  of  Pregnancy  is  re- 
flected in  an  Opposite  Direction,  from  the  Motlier  to  the  Child  .  .     ;■'(• 


CHAPTER    IV. 

PA  TERN  A  L    HEREDITY. 

Dangers  relative  to  the  Child — Pecent  Doctrines  tending  to  limit,  and  even  to 
deny  altogether  the  Hereditary  Influence  of  Paternal  Syphilis— Exaggerations 
and  Errors  of  such  Doctrines — Discussion — Theoretic  Induction— Facts  fur- 
nished by  Observation — It  is  absolutely  true  that  Syphilitic  Husbands  beget 
Healthy  Children,  their  Wives  remaining  uninfected — Examples — Syphilitic 
Fathers  may  beget  Healthy  Children,  while  actually  presenting  Syphilitic 
Symptoms  at  the  Moment  of  Conception  or  subsequently  thereto — But,  on  the 
other  hand,  the  Paternal  Influence  is  exercised  upon ihe  Cliild  in  the  follow- 
ing Ways:  1.  Sometimes  by  Direct  Transmission  of  the  Syphilis;  2.  Much 
more  frequently  by  Death  in  Utero.,  Successive  Abortions,  Inaptitude  for  Life 
revealing  itself  by  Death  very  shortly  after  Birth ;  3.  By  Native  Degenera- 
tion of  the  Germ,  revealing  itself  afterward  under  Various  Morbid  Forms, 
such  as  Constitutional  Vices,  Inherent  Infirmities,  Arrests  of  Development, 
Congenital  Malformations,  etc.       ....... 

CHAPTER    V. 

MIXED    HEREDITY. 

A  Syphilitic  Father  is  dangerous  to  his  future  Children  on  Account  of  the  Syphi- 
lis which  he  may  communicate  to  his  Wife — Disastrous  Consequences  to  the 
Offspring  of  a  Contagion  transmitted  to  the  Mother — When  Father  and 
Mother  are  both  syphilitic  the  Future  of  the  Child  is  comprised  within  the 
Three  Following  Alternatives:  1.  Death  in  Uter'o.,  Abortion,  Accouchement 
before  Term  ;  2.  Hereditary  Syphilis  ;  3.  Syphilitic  Heredity  wiih  Dissimilar 
Morbid  Forms— Native  Debility — Inexplicable  Sudden  Death — Hereditary 
Morbid  Aptitudes — Predisposition  to  Affections  of  the  Nervous  System — 
Convulsions— Meningitis — Backward,  Imbecile,  and  Idiotic  Children — Hydro- 
cephalus— Lyinphatism,  Scrofula — Scrofula  not  a  Degeneration  of  Syphilis  as 
has  been  said,  but  Syphilis  certainly  constitutes  one  of  the  Affluents  of 
Scrofula  .......... 


CHAPTER    VI. 

MA  TERN  A  L    HEREDITY. 

Parallel  betv.-con  Paternal  and  Maternal  Syphilis  as  regards  their  Hereditary  In- 
fluence— The  Maternal  Influence  is  veritably  pernicious  for  the  Child — Per- 
sonal Statistics — Other  Statistics  furnishing  Similar  Results — Conclusion,  the 
Worst  Danger  for  the  Offspring  is  for  the  Mother  to  contract  the  Infection  from 
the  Father      ..........     OG 


CONTENTS.  ix 

CHAPTER    VII. 

PEBSOKAL  jyANGTCnS   OF  THE  HUSBAND. 

v:a,v. 
How  a  Syphilitic  Man  may  become  dangerous  to  liis  Family  from  the  PerKonal 
Eisks  to  which  he  remains  exposed  from  his  Disease — Catastrophes,  Social 
Calamities  resulting  from  the  Syphilis  of  the  Husband — Various  Examples — 
Moral  Aspect  of  the  Question — Has  a  Syphilitic  Man  the  Eight  to  associate 
Others,  viz.,  a  "Wife  and  Children,  in  the  Future  Dangers  of  a  Syphilis  insuf- 
ficiently treated  ? — Marriage  in  such  Conditions  a  Culpable  Action  which 
Morality  sternly  reproves — The  Dangers  to  which  a  Syphilis  not  treated  ex- 
poses the  Patient  after  a  Long  Maturity — Duty  of  the  Physician  to  enlighten 
his  Patients  upon  these  Points — Conclusions        .  .  .  .  .76 


CriAPTEE    VIII. 

CONDITIONS  OF  ADMISSIBILITY  10  MARRIAGE— ABSENCE  OF  ACTUAL 
SPECIFIC  ACCIDENTS— ADVANCED  AGE  OF  THE  DIATHESIS. 

In  what  Conditions  does  a  Patient  affected  with  Syphilis  become  admissible  to 
Marriage — The  Author's  Programme — Principal  Conditions— Absence  of  Ac- 
tual Specific  Accidents — Incredible  Audacity  of  Persons  who  marry  while 
having  Actual  Symptoms  of  Syphilis — Various  Motives  influencing  this  Revolt- 
ing Act— Examples  of  Marriage  during  the  Incubation  of  Syphilis^Advaneed 
Age  of  the  Diathesis — General  Principle  ;  the  more  recent  the  Husband's 
Syphilis,  the  more  numerous  and  the  more  serious  the  Dangers  which  he  intro- 
duces into  Marriage — Corollary  : — The  Advanced  Age  of  the  Diathesis  consti- 
tutes a  Security  for  Marriage  :  1.  From  the  Point  of  View  of  the  Eisks  of 
Contagion ;  a  Recent  Syphilis  is  especially  dangerous  from  the  Character  of 
its  Accidents,  their  Multiplicity,  their  Frequent  Eecurrences,  their  Tendency 
to  Localization  toward  tlie  Mouth  and  the  Genital  Organs,  their  Apparent  Be- 
nignity, etc. ;  2.  Attenuating  and  Corrective  Influence  of  Time  upon  Heredity ; 
Gradual  Decrease  and  Final  Extinction  of  the  Eeaction  of  the  Parents  upon  the 
Children;  Probatory  Examples  ;  3.  Comparative  Guarantee  furnished  by  the 
Long  Standing  of  the  Disease  as  to  the  Husband's  Personal  Eisks — Age  of  the 
Syphilis  not  the  Sole  Fact  from  which  to  judge  of  the  Admissibility  or  Noii- 
admissibility  to  Marriage— Other  Factors  to  be  consulted— Difficulties  in 
determining  the  Exact  Time  when  a  Syphilitic  becomes  admissible  to  Marriage 
—The  Minimum  Period  to  be  exacted,  Three  or  Four  Years  usefully  devoted  to 
Specific  Treatment— Marriage  then  tolerated  ratherthan  counseled— A  Longer 
Time  afi'ords  a  Safer  Guarantee       .  .  .  .  .  .  .     04 


CHAPTER    IX. 

PROLONGED  PERIOD  OF  IMMUNITY— NON-MENACING  CHARACTER  OF   THJi 

DIATHESIS. 

Stage  of  Immunity  sufficiently  prolonged  after  Last  Specific  ManifestatioDS — Prog- 
nostic Significance  of  this  Period — Security  much  greater  when  this  Period  is 
passed  without  Therapeutic  Intervention — What  Duration  should  be  assigned 


CONTENTS. 

PAon 
to  tliis  Period  of  Immunity — Mininium  strictly  required  for  Marriage — Non- 
raenaciDg  Character  of  the  Diathesis — Original  Benignity  of  a  Syphilis  a  Fa- 
vorable Condition  for  Marriage,  but  does  not  supply  other  Required  Conditions 
— Syphilis  originally  benign  may  afterward  terminate  in  the  Gravest  Acci- 
dents— It  may  become  dangerous  for  Marriage,  not  only  from  the  Point  of 
View  of  Contagion  and  Heredity,  but  also  from  the  Personal  Eisks  of  the 
Husband— Orders  of  Syphilis  especially  dangerous  for  Marriage— Syphilis 
with  Continually  Recurring  Crops  of  Secondary  Accidents— Syphilis  with 
Grave  and  Diverse  Manifestations- Syphilis  electing  for  its  Morbid  Determi- 
nation some  Important  Organ,  as  the  Eye,  Brain,  Spinal  Cord,  etc.— Syphilis 
of  this  Order  absolutely  incompatible  with  Marriage— The  Intrinsic  Prognosis 
of  each  Particular  Case  necessary  to  form  a  Judgment    .  .  .  .111 


CHAPTER    X. 

SUFFICIENT  SPECIFIC  TREATMENT. 

The  Great  Condition  par  excellence — Sufficient  Specific  Treatment  the  most  Valu- 
able and  Substantial  Guarantee  of  a  Syphilitic's  Fitness  for  Marriage :  1.  It 
constitutes  the  Best  Safeguard  against  the  Husband's  Risks ;  2.  It  diminishes 
and  suppresses  the  Dangers  of  Contagion ;  3.  It  diminishes  and  suppresses 
the  Dangers  of  Heredity — Influence  of  Specific  Treatment  upon  Paternal 
Heredity,  upon  Maternal  Heredity,  upon  Mixed  Heredity — A  Provisional 
Treatment  may  counteract,  temporarily,  the  Efi'ects  of  Syphilitic  Heredity — 
What  Treatment  offers,  if  not  Absolute  Security,  at  least  Substantial  Guaran- 
tees— Deplorable  Results  of  Short  Treatments — A  Chronic  Disease  requires 
Chronic  Treatment— Plan  of  Treatment  sufficiently  protective,  both  for  the 
Present  and  the  Future        .  .  .  .  .  .  .  .122 


CHAPTER    XI. 

THE  USE  OF  SULPnUJi- WATERS- CONCLUSIONS. 

Sulphur-Waters  as  a  Criterion  of  the  Cure  or  the  Non-cure  of  Syphilis— Their  so- 
called  Revealing  Action — What  Degree  of  Confidence  may  be  accorded  to 
"  the  Judgment  of  the  Waters  " — The  Test  of  the  Waters,  as  applied  to  a 
Syphilitic's  Fitness  for  Marriage,  a  Legend — Conclusions — Review  of  the  Pre- 
ceding Programme — Reflections  and  Criticisms — Impossibility  of  forming  a 
Programme  which  responds  to  all  Possible  Contingencies — The  Physician's 
Opinion  must  be  based  upon  a  Simple  Calculation  of  Probabilities — How 
Medical  Intervention  in  this  Matter  may  afl"ord  Inestimable  Services,  both  to 
Patients  and  Society — How  the  Question  of  Fitness  or  Non-fitness  for  Mar- 
riage presents  itself  to  the  Physician — Rule  of  Conduct  to  be  strictly  ob- 
eerved — Empirical  Confirmation  of  the  Foregoing  Facts  .  ,  ^  ..132 


CONTENTS.  xi 


PART    II. 

AFTEK    MAHKIAGIS. 

CHAPTEE   XII. 
HUSBAND  SYPHILITIC  AND  WIFE  HEALTHY. 

PAOB 

Syphilis  anterior  to  Marriage— Syphilis  posterior  to  Marriage — Exceptional  Cases 
of  Syphilis  contracted  before  Marriage  not  manifesting  itself  until  after  Mar- 
riage— Dangers  resulting  from  the  Introduction  of  Syphilis  into  a  Young 
Family — First  Order  of  Situations  possible;  Husband  syphilitic  and  Wife 
healthy — Particular  Indications  then  to  be  fulfilled :  to  destroy  forthwith  the 
Sources  of  Contagion;  to  cut  short,  by  a  Medication  of  Especial  Intensity,  the 
Contagious  Accidents  of  the  Secondary  Period ;  to  avert  the  Dangers  which 
might  result  from  a  Pregnancy,  etc. — Two  Propositions  verified  by  Experi- 
ence :  1.  In  the  Great  Majority  of  Cases  the  Syphilitic  Contagions  transmitted 
from  Husband  to  "Wife  in  Marriage  are  derived  from  Secondary  Accidents ; 
2.  These  Contagions  are  almost  invariably  derived  from  Secondary  Accidents 
of  a  Superficial  Erosive  Form,  essentially  benign  in  Appearance,  and  suscep- 
tible of  remaining  unrecognized  as  to  their  Real  Nature,  or  of  passing  entirely 
unperceived  ..........  146 

CHAPTER   XIII. 

HUSBAND  SYPHILITIC,   WIFE  HEALTHY  BUT  ENCEINTE. 

Dangers  which  this  Situation  involves  for  both  Mother  and  Child — Discussion 
upon  the  Propriety  of  Preventive  Intervention — Diverse  Opinions — Particular 
Cases  in  which  this  Intervention  is  expressly  indicated  ....  152 

CHAPTEE    XIV. 

HUSBAND  SYPHILITIC  AND    WIFE  RECENTLY  CONTAMINATED. 

Special  Difficulties  encountered  in  this  Order  of  Cases — Eole  of  the  Physician  in 
Relation  to  the  Husband — Absolute  Interdiction  of  Paternity — Role  of  the 
Physician  in  Relation  to  the  Wife — Mission  of  the  Physician  to  treat  this 
Woman  with  the  Obligation  to  conceal  from  her  the  Name  and  Nature  of  her 
Disease — Contests  with  Feminine  Acuteness — The  Wives  not  always  the 
Dupes  of  the  Stratagem — Difficulties  of  making  a  Woman  ignorant  of  her  Dis- 
ease accept  the  Long  Treatment  necessary — The  Husband  by  no  Means  an 
Ardent  Auxiliary  of  the  Physician — Lamentable  Consequence — Most  Married 
Women  contracting  Syphilis  from  their  Husbands  are  never  sufficiently  treated, 
and  are  thus  exposed  to  the  most  Serious  Consequences  in  the  Future — Fre- 
quency of  Tertiary  Accidents  among  these  Patients — Why  the  Nature  of  such 
Accidents  is  liable  to  remain  unrecognized  in  these  Cases — Clinical  Exam- 
ples— The  Moral  Duty  here  imposed  upon  the  Physician — Multiple  Embai^ 
rassments  of  such  a  Situation — ^Professional  Tact  and  Cleverness  demanded    .  168-^ 


xii    .  COKTENTS. 

CHAPTER    XV. 
HUSBAKD  SYPHILITIC— WIFE  SYPniLITIC  AND  ENCEINTE. 

PAOB 

The  most  Serious  Sibuation  of  all — Probable  Fate  of  the  Child  procreated  under 
these  Conditions — It  is  not  impossible  that  Treatment  may  avert  a  Complete 
Disaster — Cases  where  Pregnancy  may  be  brought  to  Full  Term — Exceptional 
Cases  where  the  Child  entirely  escapes  the  Syphilis— Capital  Indication  to  be 
fulfilled,  to  treat  the  Mother — Objections — Pretended  Dangers  oi'  Mercurial 
Treatment  during  Pregnancy — Discussion — Popular  and  even  Professional 
Prejudice  attributing  to  Mercury  that  which  is  the  Result  of  Syphilis — Ab- 
solute Urgency  of  submitting  Syphilitic  Women  in  a  State  of  Gestation  to 
Specific  Treatment — Two  Existences  to  be  preserved — Confirmatory  Eesults 
of  Clinical  Experience  ........  179 

CHAPTER    XVI. 

DANGERS  TO  SOCIETY—SOCIAL  PROFUYLAXIS. 

Dangers  to  Society  from  the  Syphilis  of  Infants — Contagion  of  Nurses — Singular 
Faculty  of  Expansion,  of  Irradiation  of  the  Sypliilis  of  Nurses  and  Nurslings 
— Cascades  of  Contagion — Clinical  Examples — Duty  of  Social  Prophylaxis  im- 
posed upon  the  Physician — Object  to  be  realized :  to  circumscribe  the  Pox  in 
its  Original  Bed,  and  prevent  the  Spread  of  its  Ravages  outside — Application 
— The  Sole  Means  practicable  ;  the  Infant,  the  Prime  Origin  of  these  Dangers, 
must  remain  in  the  Family  and  be  nourished  by  its  Mother — Objections — 
Does  Maternal  Nursing  in  such  Cases  involve  Dangers  either  for  the  Mother 
or  the  Child? — Discussion — Four  Orders  cf  Cases  possible — Two  Alternatives, 
perilous  theoretically— Law  of  CoUes — In  Point  of  Fact  the  Nursing  of  the 
Child  by  its  Mother  is  free  from  the  Dangers  v/liich  might  be  supposed — 
Conclusions — Maternal  Nursing  is  the  Sole  Rational  and  Practical  Means  for 
the  Raising  of  the  Child — The  Protection  of  Society  constitutes  the  Capital, 
Pi-edominant  Indication,  which  the  Physician  is  bound  to  satisfy  .  .  195 


NOTES  AND  ILLUSTRATIVE  CASES. 

I. — Eighty-seven  Observations  relative  to  Syphilitic  Subjects  who,  having  mar- 
ried, have  never  communicated  the  least  Suspicious  Symptoms  to  their 
"Wives,  and  more,  have  begotten  a  Total  of  One  Hundred  and  Fifty-six 
Children  absolutely  healthy     .......  209 

II. — Syphilis — Seven  Abortions  or  Premature  Accouchemcnts.    (Case.)  .  .  212 

III. — Hereditary  Influence  of  Maternal  Syphilis.     (Statistics.)        .  .  .  235 

IV. — Syphilis  contracted  before  Marriage  and  not  manifesting  itself  until  after 

Marriage.     (Cases.)       ........  239 

v.— Premature  Marriage  of  a  Syphilitic  Subject — Five  Cases  of  Syphilis  origi- 
nating from  the  Husband's  Syphilis — Death  of  a    Strange  Nursling. 

(Case.)     .  .  .  .  " 213 

VI.— Father  syphilitic — Child  syphilitic — Mother  at  first  apparently  uninfected, 

but  presenting.  Six  Years  later,  an  Accident  of  Tertiary  Syphilis.    (Case.)  247 
VII. — Of  Inaptitude  for  Life  as  an  Hereditary  Consequence  of  Paternal  Syphilis  .  251 


XI! 


mTRODUCTIOISr. 

Gentlemen  :  I  propose  to  broacli  before  you,  in  a 
series  of  lectures,  a  question  wMcli,  both  in  a  medical  and 
social  point  of  view,  is  of  the  most  grave  and  important 
character,  viz.,  the  study  of  syphilis  in  its  relations  with 
marriage. 

This  question  is  eminently  complex,  as  you  may  judge 
from  its  mere  announcement.  It  embraces  a  multitude  of 
diverse  problems,  problems  difficult,  delicate,  and  peril- 
ous, which  affect  the  dearest  interests  of  families,  and 
involve  the  heaviest  responsibility  for  the  physician. 

It  is  my  desire  and  ambition,  if  not  to  solve  all  these 
problems,  at  least  to  state  and  discuss  them  before  you  in 
a  manner  to  convince  you  both  of  the  extent  of  your  duty 
to  society  in  this  respect  and  of  the  important  protective 
service  you  have  in  your  power  to  render  it. 

A  very  natural  division  of  the  subject  presents  itself 
here,  viz.  :  1st.  A  syphilitic  subject  wishes  to  marry,  and 
comes  to  consult  us  in  relation  thereto.  What  condi- 
tions ought  he  to  fulfill,  medically,  in  order  that  we  may 
be  justified  in  permitting  him  to  marry  ?    Or,  conversely, 


2  SYPHILIS  AND  MARRIAGE. 

in  what  conditions  will  it  be  our  duty  to  defer  or  even  to 
absolutely  interdict  tlie  marriage  ? 

2d.  The  marriage  is  consummated,  and  syphilis  intro- 
duced into  the  conjugal  bed.  What  medical  indications 
are  then  to  be  fulfilled  in  order  to  lessen  or  avert  the 
dangers  of  such  a  situation  ? 

In  other  words,  what  is,  what  should  be,  in  this  case 
the  role  of  the  physician  either  he/ore  or  after  marriage  ? 
Such  is  the  twofold  question  which  we  have  now  to  con- 
sider. 


PAET    I. 
BEFORE    MARRIAGE. 


CHAPTER    I. 

PEELIMINAEY   QUESTIONS. 

It  will  happen  to  you  often,  gentlemen,  in  the  course 
of  your  practice,  to  see  a  patient,  known  or  unknown  to 
you,  present  himself  in  your  office,  who,  with  countenance 
preoccupied,  almost  anxious,  will  address  you  as  follows : 
"Doctor,  I  am  contemplating  marriage.  I  have  not  al- 
ways been  discreet  in  my  bachelor  life,  and,  what  is  worse, 
I  have  not  always  been  fortunate.  I  contracted  syphilis 
at  such  a  time.  I  have  had  such  and  such  accidents.  I 
have  been  treated  in  such  and  such  a  manner.  The  matter 
is  now  a  serious  one  for  me.  I  have  come  to  ask  you  if  I 
am  thoroughly  cured,  and  if  I  can,  without  danger  for  my 
wife,  without  danger  for  my  prospective  children,  contract 
the  union  which  I  propose.  Be  good  enough  to  examine 
me,  to  interrogate  me,  and  to  give  me  your  opinion  upon 
this  subject."  Now,  when  such  a  request  is  addressed  to 
you,  gentlemen,  do  not  misapprehend  the  gravity  of  the 
question.  Your  response  involves  interests  the  most  seri- 
ous, the  most  sacred,  the  most  dear  to  the  heart  of  every 
honorable  man,  of  every  respectable  family,  as  well  as  in- 


4  SYPHILIS  AND  MARRIAGE. 

terests  the  most  diverse  and  the  most  multij)lied.  By  this 
opinion  which  you  are  about  to  formulate,  you  incur  a 
responsibility  which  I  can  not  otherwise  characterize  than 
as  considerable ;  and  I  do  not  think  I  exaggerate  in  say- 
ing that  in  the  province  of  the  physician  there  are  few 
problems  to  solve,  on  the  one  hand  so  grave,  and  on  the 
other  hand  so  complex,  so  diihcult,  so  delicate,  as  this. 

Judge  for  yourselves,  now,  and  see  what  might  be 
the  consequences  of  an  error  committed  by  you  in  such  a 
situation.  Suppose  that  the  physician  pronounces  incon- 
siderately under  such  circumstances,  and  falls  into  one  or 
other  of  the  only  two  errors  possible  to  commit  in  the 
case.  What  deplorable  results  does  he  not  bring  uxDon 
his. patient ! 

First  HypotJiesis. — Take  the  case  of  a  patient  who, 
although  having  had  syphilis  formerly,  is,  nevertheless, 
by  reason  of  the  treatment  he  has  undergone  and  the 
present  state  of  the  diathesis,  in  a  condition  to  contract 
marriage.  The  physician  consulted  in  this  case  mistalces 
the  situation  of  his  patient,  and  forbids  his  marriage. 
Consequence  :  Here  is  a  man  wrongly  condemned  to  celi- 
bacy, banished  from  the  virtuous  life  which  he  i:)roposed 
to  enter,  and  relegated  to  an  irregular  life,  with  all  the 
miseries,  social  or  otherwise,  which  it  entails.  Here  is  a 
man  whose  future  and  whose  heart  are  both  broken  by  a 
medical  decree  that  forces  him  to  renounce  a  union 
likely  to  assure  his  position  and  his  happiness ;  here,  at 
all  events,  is  a  man  deprived  of  family  life,  deprived  of 
those  two  things  which,  after  the  turbulence  of  the  first 
years  of  foolish  youth,  become  the  objects  of  natural  and 
universal  aspiration,  viz.,  home  and  children. 

Second  Hypothesis. — The  error  is  committed  in  an 
opposite  direction,  and  the  physician  prematurely  sane- 


PRELIMINARY  QUESTIONS.  5 

tions  the  marriage  of  a  man  whose  syphilis  is  still  active 
and  dangerous. 

Then,  indeed,  the  consequences  of  such  a  mistake  are 
truly  disastrous  and  ruinous,  for : 

1st.  This  man  may  infect  his  wife.  And  what  is  more 
deplorable  than  to  give  a  virtuous  young  woman  the  po:;c 
as  a  wedding  present ! 

3d.  This  infected  couple  will  engender  children  that 
will,  inevitably,  either  die  almost  as  soon  as  they  are  con- 
ceived, or  be  born  with  the  father's  disease.  And  what 
more  hideous  for  a  young  household  than  the  pox  in  the 
cradle ! 

To  say  nothing  of  other  possible  consequences  of  such 
a  situation,  such,  for  example,  as  the  infection  of  the 
nurse,  etc.^ 

Take  my  word  for  it,  gentlemen,  I  have  witnessed  many 
scenes,  many  dramas  of  this  kind,  and,  I  declare,  I  know 
of  no  position  more  heart-rending,  more  lamentable,  more 
atrocious  than  that  of  a  man  who  has  introduced  the  pox 
into  his  little  household — than  the  situation  of  this  man 
(1st)  in  regard  to  his  disconsolate,  weeping  wife,  whose 
tears  are  not  even  accompanied  with  recriminations  or 
complaints,  for  love  and  affection  readily  forgive  ;  (2d)  in 
regard  to  a  new  family  that  will  not  pardon,  that  has  the 
right  to  be  severe,  and  exercises  that  right ;  (3d)  in  regard 
to  the  infant  which  miserably  vegetates,  and,  in  place  of 
being  the  beautiful  child  dreamed  of  by  the  relatives  and 
mother,  is  to  every  one,  even  to  the  nearest  kin,  but  an 
object  of  disgust  and  horror ;  (4th)  finally,  in  regard  to 
an  infected  nurse,  who  threatens,  who  makes  scandal, 

*  In  another  series  of  lectures,  I  have  studied  the  serious  consequences  of 
infantile  syphilis  in  relation  to  nurses. — Nourrices  et  nourrisojis  syphiliiiques. 
Paris,  18'78. 


6  SYPHILIS  AND' MARRIAGE. 

who  di^nilges,  who  throws  disgrace  u^on  the  family,  etc. 
Picture  to  yourselves  such  a  scene,  gentlemen,  and  judge 
of  the  regret,  of  the  martyrdom,  of  the  man  who  has 
caused  such  afflictions. 

Now,  it  is  situations  of  this  kind  which  you,  as  physi- 
cians, are  privileged  to  avert,  thanks  to  your  art,  your 
experience,  your  authority.  It  is  situations  of  this  kind 
which  it  is  necessary  for  you  to  take  in  at  the  first  glance, 
when  a  syphilitic  patient  comes  to  consult  you  upon  the 
admissibility  of  marriage  ;  and  it  is  these  which  you  should 
have  present  in  your  mind  when,  in  one  way  or  the  other, 
you  formulate  your  response — let  us  say,  rather,  when 
you  pronounce  your  sentence.  Judge,  then,  from  these 
few  words,  gentlemen,  on  the  one  hand,  what  an  important 
and  exalted  post  is  yours  in  your  capacity  as  arbiters  in 
such  a  matter  ;  and,  on  the  other  hand  also — I  again  insist 
upon  this  point — what  responsibility  you  incur  for  the 
results  that  may  follow.  Judge  what  service  you  are 
called  upon  to  render  your  patient  in  either  alternative : 
whether  you  permit  him  to  marry,  if  expedient ;  whether, 
on  the  contrary,  and  better  still,  you  enlighten  him  upon 
the  possible  consequences  of  his  condition  (consequences 
which  perhaps  he  is  ignorant  of,  or  which,  at  least,  he  but 
imperfectly  comprehends),  and  thus  preserve  him  from 
the  frightful  predicament  in  which  he  Avas  about  to  in- 
volve himself. 

And,  again,  note  this  :  At  the  moment  when  you  render 
your  decision,  it  is  not  alone  the  patient's  interests  that 
you  hold  in  hand  ;  your  protective  office  extends  beyond 
him,  and  reaches  farther.  For  behind  that  patient  there 
is  a  young  wife,  there  are  children  yet  unborn,  there  is  a 
family,  there  is  society  itself,  to  be  shielded  at  the  same 
tii^e  by  your  prohibition.     Behold,  then,  how  extended 


PRELIMINARY  QUESTION'S.  Y 

and  elevated  the  medical  adviser's  mission  becomes  when 
lie  finds  himself  thus  the  arbiter  of  so  many  united  in- 
terests. 

Before  entering  into  the  heart  of  this  question  and  dis- 
cussing the  different  problems  which  will  be  the  object  of 
this  exposition,  let  us  first  state  a  principle  by  endeavoring 
to  define  clearly  the  situation,  as  it  presents  itself  in  prac- 
tice, and  determining  exactly  the  role  which  is  assigned  us. 

When  a  patient  comes  to  request  our  advice,  to  ask 
our  counsel  upon  the  propriety  of  marriage,  despite  syphi- 
litic antecedents,  it  is  as  pTiysicians,  as  physicians  exclu- 
sively, that  we  are  consulted.  Our  role  is  distinctly  de- 
termined by  that  fact  alone.  It  is  as  physicians  that  we 
are  to  respond.  In  other  words,  it  is  a  question  of  pathol- 
ogy, and  of  that  only,  that  we  are  called  upon  to  judge, 
and  our  duty,  our  absolute  duty,  is  to  decide  it  upon 
pathological  grounds  alone,  without  allowing  ourselves  to 
be  influenced  by  any  other  considerations,  whatever  they 
may  be. 

But,  you  ask  me,  wherefore  this  preface?  "Why  this 
rule  of  conduct  laid  down  at  the  opening  of  the  exposi- 
tion? 

In  practice,  gentlemen,  it  is  necessary  to  look  upon 
things  as  they  exist,  and  to  take  men  for  what  they  are. 
N'ow,  learn  this,  presuming  that  you  may  not  know  it 
already  :  among  the  numerous  patients  who  will  come  to 
consult  you  upon  the  propriety  of  marriage  in  the  special 
conditions  which  now  engage  our  attention,  there  are 
many,  assuredly  (let  us  even  say  a  very  large  majority), 
who  will  present  themselves  to  you  with  the  twofold  in- 
tention of  learning  precisely  how  to  act  in  their  situation, 
and  of  submitting  themselves  to  the  decision  which  you 


8  SYPHILIS  AND  MARRIAGE. 

will  pronounce  ;  that  is  to  say,  of  renouncing  a  projected 
marriage,  if  you  prohibit  them  from  marrying.  This  class 
you  do  not  have  to  distrust.  But  there  are  others  of  an 
altogether  different  Idnd  ;  and  these  last,  more  numerous 
than  you  would  suppose  a  priori,  will  come  to  you  with  a 
tacitly  formed  resolve  to  act  solely  according  to  their  in- 
clination, whatever  you  may  say  to  them,  and  to  marry  at 
all  hazards,  and  m  spite  of  all  your  interdictions,  because 
it  pleases  them  to  marry,  because  they  have  resolved  to 
marry,  before  even  crossing  your  threshold. '^'     In  these 

*  I  have  seen  numbers  of  syphilitic  subjects  marry  in  opposition  to  all  medical 
prohibitions. 

One  can  not  even  form  an  idea  of  the  disdainful  indiffei'ence  which  certain 
people  profess  with  regard  to  medical  prescriptions  concerning  the  subject  under 
consideration.  .  ,  . 

One  of  our  most  learned  and  esteemed  confreres,  Dr.  X.,  was  consulted  by  a 
young  man,  the  son  of  a  family  of  his  most  intimate  friends,  for  accidents  of  sec- 
ondary syphilis  consecutive  to  a  recent  contagion.  Knowing  that  the  young  man 
was  then  contemplating  marriage,  he  took  occasion  to  accompany  his  prescription 
with  a  long  moral  upon  the  dangers  of  syphilis  in  relation  to  marriage,  and  endeav- 
ored to  obtain  from  his  patient  a  formal  renunciation  of  all  matrimonial  projects. 
...  In  response,  he  received,  some  weeks  later,  a  letter  announcing  the  marriage, 
with  an  invitation  to  be  present  at  the  ceremony,  celebration,  dinner,  etc. 

It  is  useless  to  speak  of  the  reception  given  to  this  ironical  missive  by  our  con- 
frere. 

But  the  expiation  could  not  be  long  delayed,  and  it  was  severe,  as  you  will  see. 

Three  months  later,  the  young  couple  presented  themselves  to  Dr.  X.,  under  the 
pretext  of  a  "  visite  de  noces."  After  the  usual  compliments,  the  young  husband 
suddenly  changed  the  conversation,  and  requested  some  medical  advice  for  his  wife, 
who,  in  the  first  place,  presented  the  earlier  symptoms  of  pregnancy,  and  who,  in 
addition,  had  had  for  some  weeks  a  "  slight  hardness  "  on  the  lip.  Now,  upon  ex- 
amination, this  was  found  to  be  nothing  else  than  a  syphilitic  chancre — a  chancre 
manifestly  transmitted  to  the  young  wife  from  her  husband,  who  had  not  ceased 
for  some  months  to  be  affected  with  buccal  syphihdes,  and  was  still  affected  with 
them  at  that  time. 

It  is  almost  superfluous  to  add  that  the  chancre  was  followed  by  the  accidents 
of  constitutional  syphilis.  In  addition  to  which,  eight  months  later,  the  young 
wife  was  delivered  of  a  poor,  weakly,  insignificant  infant,  which  was  soon  covered 
with  syphilides,  and  quickly  succumbed. 

Another  example  of  the  same  kind : 

A  young  man  contracts  syphilis  and  comes  to  seek  treatment  from  me.  Some 
months  later,  still  affected  with  secondary  accidents,  he  announces  to  me  that  he 


PRELIMINARY  QUESTIONS.  9 

cases,  it  is  not  advice,  not  counsel  whicli  they  expect  of 
you  ;  it  is  your  consent,  your  acquiescence  in  their  proj- 
ects which  they  hope  to  wring  from  you.  Such  consent, 
indeed,  would  set  them  at  ease  with  their  consciences,  and, 
moreover,  should  things  happen  to  "turn  out  badly"  in 
the  future,  it  would  serve  them  as  an  excuse  and  an 
exoneration. 

N^ow,  in  order  to  gain  their  ends,  in  order  to  force  your 
convictions,  those  of  this  latter  category,  while  pretending 
to  consult  you,  never  fail  to  shirk  the  medical  aspects 
of  the  question  almost  at  once,  in  order  to  carry  you  off 

finds  himself  engaged,  "  almost  in  spite  of  himself,"  to  be  married,  which  must 
necessarily  take  place  quite  soon.  I  energetically  insist  upon  his  renouncing  such 
a  project ;  I  depict  to  him  the  dangers  to  which  he  is  about  to  expose  himself  and  his 
future  family.  I  endeavor  to  convince  him  of  the  immorality,  of  the  culpability 
of  such  an  act,  etc.  Nevertheless,  he  marries,  and  I  see  him  no  more  for  a  certain 
time. 

Some  months  later  he  comes  to  me  in  a  veritable  state  of  affright  and  distress. 
He  has  infected  his  wife,  he  tells  me,  and  he  comes  to  ask  my  attentions  to  her. 
I  find,  in  reality,  this  young  wife  in  an  active  condition  of  syphilis.  I  prescribe  a 
treatment,  a  hygiene,  etc.,  and,  especially,  I  expressly  recommend  the  husband  to 
avoid  at  any  price  the  possibility  of  pregnancy  in  such  a  situation.  I  explain  to 
him,  superabundantly,  that  a  pregnancy  would  be  a  second  disaster,  for  it  could 
only  end,  according  to  every  probability,  either  in  an  abortion  or  in  the  birth  of  a 
syphilitic  infant. 

Notwithstanding,  two  months  later,  the  young  wife  becomes  enceinte.  I  then 
treat  her  so  much  the  more  energetically,  and  I  have  the  happiness  to  prevent  an 
abortion.  Then,  when  I  consider  myself  sure  of  obtaining  an  accouchement  at  full 
term,  I  announce  the  express  absolute  obligation  for  the  mother  to  nurse  her 
child.  At  least,  I  say  to  the  husband,  arrange  it  so  as  to  avoid  a  third  misfortune. 
Do  not  confide  your  infant  to  a  nurse,  for  it  is  quite  probable  that  the  nurse  will 
receive  the  pox  from  it.  M.  Ricord,  consulted  upon  this  point,  confirms  the  appre- 
hensions expressed  by  myself,  and  energetically  insists  upon  the  absolute  neces- 
sity of  the  mother  nursing  the  child. 

Some  months  pass  away,  without  my  again  seeing  this  family.  Then,  one  day, 
the  father  reappears,  bringing  the  child  covered  with  syphilides,  and  the  nurse  to 
whom  this  child  had  been  confided.  As  I  had  foreseen,  this  nurse  had  become  in- 
fected, and  bore  upon  one  of  her  breasts  an  indurated  chancre  of  the  most  typical 
character. 

To  recapitulate :  triple  transgression  of  medical  advice  and  triple  disaster,  viz., 
the  infection  of  a  young  wife,  the  birth  of  a  syphilitic  infant,  and  the  contamination 
of  a  nurse. 


10  SYPHILIS  AND  MARRIAGE. 

to  considerations  of  a  totally  different  character.  They 
have  a  hundred  pretexts  at  their  service  to  plead  their 
cause  and  to  induce  you  to  share  then*  feeling.  One,  for 
example,  "has  given  his  word,  he  is  engaged,  formally 
engaged,  and  you  should  not  compel  him  to  break  his 
plighted  faith." 

Another  will  invoke  an  urgent  material  necessity. 
Counting  upon  the  do\viy  of  his  future  wife,  he  has  just 
purchased  an  office,  a  practice,  a  commercial  business,  or 
the  like.  "If  you  force  him  to  break  off  the  marriage,  it 
will  be  to  bring  him  to  ruin,  failure,  and  dishonor." 

Still  another,  more  crafty,  will  work  upon  your  feel- 
ings. "I  love  a  young  lady,"  he  will  tell  you,  "and  am 
beloved  of  her.  Our  two  families,  our  aged  parents,  place 
thek  dearest  hopes  on  this  marriage,  and  a  rupture  would 
break  all  our  hearts,"  etc. 

All  these  arguments  (copied  from  life,  and  reproduced 
literally,  on  my  honor) — all  these  arguments,  and  many 
others  which  I  pass  in  silence,  have  nothing  to  do,  gentle- 
men, with  the  situation  which  we  are  called  upon  to  ex- 
amine as  physicians.  Were  such  reasons  as  valid  as  they 
are  detestable,  we  have  nothing  whatever  to  do  vniln  them, 
nor  have  they  any  value  for  us  medically.  Let  them  be 
null  and  void  for  us.  Let  us  stand  firm  under  such  cir- 
cumstances and  reject  everything  that  does  not  bear  upon 
the  clinical  aspect  of  the  case.  Let  us  not  quit  our  own 
ground,  but  confine  ourselves  to  a  strictly  pathological 
view  of  a  question  which  for  us  should  not  be  separated 
from  pure  pathology.* 

I  will  even  go  farther,  and  assert  that  we  should  be 
culpable,  veritably  culpable,  were  we  to  do  otherwise ; 

*  Of.  Langlebert,  La  syphilis  dans  ses  rapports  avcc  le  mariage.    Paris,  1873, 
p.  10. 


PRELIMINARY  QUESTIONS.  11 

that  is  to  say,  were  we  to  allow  ourselves  to  arrive  at  a 
decision  based  upon  considerations  foreign  to  our  art. 
And  tlie  proof  of  this  is  the  embarrassment  which  we 
should  have  in  Justifying  our.  conduct  if  a  misfortune 
should  occur,  if  a  patient,  whom  we  had  permitted  to 
marry  from  extra-medical  considerations,  should  happen 
to  introduce  syphilis  into  his  family.  What  plea  could 
we  then  urge  against  such  an  accusation  thrown  in  our 
face  as,  "What!  you  judged  this  man  to  be  medically 
unfit  for  marriage,  dangerous  for  marriage,  and,  because 
he  has  alleged  questions  of  convenience,  of  position,  of 
pecuniary  wants,  of  feelings,  you  authorized  him  to  run 
the  risk  of  introducing  the  pox  into  his  home  !  " 

Let  us  guard  against  the  possibility  of  such  recrimina- 
tions, let  us  guard  against  a  grave  fault  into  which  (I  can 
say  from  experience)  we  are  but  too  easily  led  by  an  ex- 
cess of  kindness  ;  the  more  so,  as  we  have  a  ready  means 
of  avoiding  it,  viz.,  not  to  deviate  from  the  role  naturally 
assigned  to  us  by  our  profession. 

In  a  word,  consulted  under  such  circumstances,  let  us 
keep  to  medicine,  and  Judge  only  as  physicians  the  case 
submitted  to  us.  Let  there  be  no  concessions  to  argu- 
ments of  a  foreign  nature ;  no  condescensions  which  we 
may  bitterly  regret  in  the  future,  and  which,  without  bene- 
fiting any,  may  prove  prejudicial  to  all,  seriously  compro- 
mising both  our  authority  and  our  dignity. 

With  these  preliminaries,  we  shall  enter  upon  the  prin- 
cipal subject.  But,  first  of  all,  let  us  examine  a  primary 
question,  which,  if  resolved  affirmatively,  would  exclude 
all  further  discussion,  by  rendering  useless  that  which  is 
now  to  follow. 

Does  syphilis  constitute  an  express  interdiction^  an 
absolute  obstacle^  to  marriage  f 


12  SYPHILIS  AND  MARRIAQE. 

Witliout  doubt,  gentlemen,  you  have  often  heard  the 
common  adage,  '''■  avec  la  'oerole  il  faitt  r ester  gargony 
Many  people  repeat  and  spread  this  as  an  axiom  indorsed 
by  all  the  faculty,  who,  moreover,  in  order  to  discourse 
more  at  ease  of  such  things,  have  never  taken  the  care  to 
study  them.  It  is  also  affirmed  in  a  much  more  energetic 
manner  by  families  (and  I  excuse  them),  who  have  been  in- 
terested in  the  question  and  seen  syphilis  introduced  into 
their  household  under  cover  of  marriage.  These  families 
can  not  sufficiently  reprobate  every  man  who,  with  the 
syphilis,  would  dare  ever  to  aspire  to  the  position  of  hus- 
band. In  their  oj)inion,  and  in  the  opinion  of  all  those 
who  have  been  the  victims  of  similar  calamities,  the  pox 
is  radically  "  incomj)atible  with  marriage." 

By  many  physicians,  syphilis  would  be  regarded  as  an 
express  contraindication  to  marriage.  I  have  had  the 
pleasure  of  conversing  upon  this  subject,  which  has  for 
many  years  engaged  my  attention,  with  numbers  of  my 
confreres,  and  many  of  them  have  said  this  to  me  in  their 
own  words  :  "  Nobody  marries,  no  one  ought  ever  to  mar- 
ry, when  once  he  has  had  the  misfortune  to  contract  the 
pox."  I  could  even  cite  two  of  our  most  esteemed  con- 
freres who  have  joined  practice  to  precept,  who  have  ex- 
emplified it  by  remaining  unmarried,  from  the  sole  con- 
sideration that  they  had  acquired  syphilis  in  their  life  as 
students.  One  of  them,  a  most  distinguished  physician, 
whose  heart  is  on  a  level  with  his  talent,  has  never  allowed 
himself  to  be  dissuaded  by  me  (who  have  the  honor  to  be 
his  friend)  from  that  which  he  tenns  his  "incapacity  for 
marriage."  "You  have  spoken  to  no  purpose,"  he  has 
repeated  to  me  a  hundred  times.  "When  one  has  the 
pox,  one  should  keep  it  to  himself,  A\ithout  running  the 
risk  of  giving  it  to  others,  especially  to  his  wife  and  chil- 


PRELIMINARY  QUESTIONS.  13 

dren."  To  wMcli  I  have  rejoined,  on  my  part,  "  Wlien  one 
has  the  pox,  one  should  cure  it ;  and  when*  by  force  of 
care  one  has  rendered  it  innocuous  for  others  as  well  as 
hin:iself,  then,  having  again  entered  upon  a  normal  condi- 
tion, one  has  the  moral  right  to  aspire  to  marriage." 

And,  in  fact,  gentlemen,  the  truth  is  not  with  those 
who  would  make  of  syphilis  an  insurmountable  obsta- 
cle, a  permanent,  eternal,  absolute  interdiction  to  mar- 
riage. 

The  truth  is,  that,  save  very  rare  exceptions,  syphilis 
constitutes  only  a  temporary  interdiction  to  marriage, 
and  that  a  syphilitic  subject  may,  after  a  certain  stage  of 
sufficient  depuration,  return  to  a  state  of  health  which 
fully  restores  his  fitness  for  the  double  role  of  husband 
and  father. 

Upon  this  point,  I  appeal  to  common,  to  daily  observa- 
tion. Do  we  not  encounter  almost  every  moment,  both  in 
private  and  hospital  practice,  persons  who,  having  had 
syphilis  in  their  youth,  afterward  marry,  and  who,  mar- 
ried, on  the  one  hand,  Tiave  netier  communicated  anytliing 
syphilitic  to  their  loives,  and,  on  the  other  hand,  have  had 
healthy  children^  well  developed  and  thriving,  as  active 
and  as  well  favored  as  could  be  desired. 

Cases  of  this  kind  abound  and  superabound.  I  deny 
that  any  physician  engaged  in  practice  for  several  years 
can  not  bring  forward  his  contingent  of  personal  ex- 
amples to  the  support  of  the  proposition,  so  consoling, 
which  I  have  Just  enunciated.  For  my  part  alone,  I 
have  in  hand  (to  speak  only  of  recorded  facts)  eighty- 
seven  observations  relative  to  syphilitic  subjects,  undoubt- 
edly syphilitic,  who,  having  married,  have  never  com- 
municated to  their  wives  the  least  suspicious  phenome- 
non ;   and,   what  is  more,  have  begotten,  these  eighty- 


14:  SYPHILIS  AND  MAERIAOE. 

seven,  a  total  of  one  liundred  and  fifty-six  cMldren  abso- 
lutely healthy.* 

These  observations,  which  I  have  chosen  among  many 
others,  are  the  most  convincing  to  me,  and  they  will  be- 
come so  to  you,  gentlemen,  I  trust,  when  I  shall  have 
assured  you  that  they  all  relate  to  patients  and  to  families 
that  I  have  scrupulously  examined  and  followed  up,  that 
I  have  had  under  observation  for  many  years,  and  many 
of  whom  are  still  in  close  relations  with  me.  In  addition, 
allow  me  to  cite  you  two  of  these  cases  as  examples : 

Two  of  my  patients,  f onnerly  syphilitic,  married,  one 
without  consulting  me,  the  other  after  having  received  my 
consent.  The  first  has  to-day /bztr  children,  and  the  sqg- 
ondi  Jive.  Now,  after  a  dozen  years  that  I  have  been  the 
physician  of  these  two  families,  I  can  affirm  to  you  with 
every  assurance  that  (1)  the  wives  of  these  two  patients  have 
never  presented  the  least  suspicious  phenomenon,  or  the 
slightest  manifestation  which  had  any  analogy  with  syph- 
ilis ;  (2)  that  the  nine  children  of  these  two  families  are 
absolutely  sound  and  healthy.  Thanks  to  the  solicitude 
of  their  mothers,  I  have  been  able  to  look  after  them  at 
leisure,  from  their  birth  until  the  present  time,  not  only 
in  theu'  various  sicknesses,  but  in  the  slightest  indispo- 
sition, vdth  which  they  have  been  affected.  Never  have  I 
detected  in  them  anything  which  recalled  the  paternal  dis- 
ease in  any  degree  or  in  any  form  whatever.  What  more 
do  you  wish  ?  Here,  then,  incontestably,  are  two  families, 
where  the  syphilis  of  the  father  has  x)layed  no  role  what- 
ever, where  things  have  progressed  as  they  would  have 
progressed  in  the  absence  of  any  syphilitic  antecedent. 

One  of  these  two  families  (pardon  me  this  incidental 
digression)  presents  the  perfected  type  of  domestic  happi- 

*  V.  Notes  and  Illustrative  Cases,  Note  1. 


FRELIMINAEY  QUESTIONS.  15 

ness,  and  lias  more  than  once  suggested  to  me  a. reflection 
relative  to  the  subject  we  are  now  considering.  I  have 
often  said  to  myself,  when  seated  at  this  happy  hearth- 
stone, and  a  witness  of  its  intimate  joys  :  "  What  a  mis- 
take should  I  have  committed  if,  from  an  exaggerated  fear 
of  the  old  disease,  I  had  prevented  this  marriage  !  What 
a  mistake  should  I  have  committed,  if  I  had  nipped  in  the 
bud  all  the  present  felicity  of  these  two  beings  so  affec- 
tionately united — if  I  had  prevented  these  beautiful  chil- 
dren from  coming  into  the  world  ! " 

Yes,  then,  a  hundred  times  yes,  one  may  marry  after 
Jiaving  had  the  pox.,  and  the  results  of  a  marriage  con- 
tracted under  these  conditions  may  be  absolutely  safe, 
medically  speaking.  This  I  afiirm  and  proclaim  boldly, 
after  having  carefully  studied  this  serious  question  from 
both  a  clinical  and  a  social  point  of  view ;  after  having 
conscientiously  investigated  numbers  of  cases,  personal  or 
contributed  by  others.  This  is  for  me  an  established 
fact,  a  demonstrated  verity. 

But,  this  said,  I  would  hasten  to  add  immediately  :  If 
one  may  marry  after  having  had  the  pox,  one  may  not,  one 
ought  not,  to  marry  in  this  special  situation  without  being 
declared  free  from  liability  to  subsequent  manifestations 
of  the  disease  ;  without  satisfying  certain  conditions  which 
are  indispensably  necessary.  What  those  conditions  are 
we  shall  now  endeavor  to  define. 


CHAPTER  II. 

DANGEES    DUE    TO    SYPHILIS    IX    MAERIAGE — DIRECT 
CONTAGIOlSr. 

IjST  order  to  deteraiine  on  what  conditions,  medically 
and  morally,  a  syphilitic  subject  may  be  permitted  to 
contract  an  alliance,  it  is  necessary,  first  of  all,  to  ascer- 
tain how  and  in  what  resj)ects  that  man  may  become 
dangerous  in  marriage. 

Such  is,  naturally,  the  primordial  point  to  establish, 
for  such  is  the  basis  of  all  reasoning  in  solving  the  'prdb- 
lem  which  is  now  imposed  upon  us. 

'Now,  in  my  opinion,  and  as  I  understand  the  question, 
a  man  with  syphilitic  antecedents  who  contracts  marriage 
may  become  dangerous  in  marriage  in  the  three  follow- 
ing relations  :  1st,  as  husband  ;  2d,  as  father  ;  3d,  as  head 
of  the  social  community  constituted  by  marriage.  In 
other  words,  he  may  become  dangerous : 

1.  To  his  wife. 

2.  To  his  children. 

3.  To  the  common  interests  of  his  family. 

Let  us  see  what  this  programme  signifies,  and  examine 
from  every  point  of  view  the  three  terms  of  the  proposi- 
tion which  I  have  Just  formulated. 

First  Point. — A  man,  toJioioitli  sypMlitic  antecedents 
contracts  marriage,  may  become  dangerous  to  Ms  wife. 


DANaERS  DUE  TO  SYPHILIS  IN  MARRIAGE.  17 

TMs  is  evident ;  it  admits  of  no  discussion,  in  fact.  It 
is  manifest  tliat  a  healthy  young  woman  delivered  over  to 
a  syphilitic  man  may  suffer  the  contre-coup  of  this  syph- 
ilis. This  is  what  common  sense  says  a  priori,  and  ex- 
perience confirms  it. 

And,  in  reality,  how  often  have  we  not  seen,  who  has 
not  seen,  cases  of  this  kind  \  A  young  woman  in  a  perfect 
state  of  health  marries  a  man  who  has  acquired  syphilis 
in  his  bachelor  life.  Several  months  later  you  find  her 
sypMUtic,  and  syphilitic  through  the  sole  agency  of  her 
husband. 

This  syphilis  in  young  married  women — we  may  say 
incidentally,  since .  occasion  presents — is  quite  frequent, 
much  more  frequent  than  one  would  suppose.  In  proof 
of  this,  you  will  find  many  cases  recorded  in  various  re- 
ports.    In  proof,  also,  the  following  personal  statistics : 

In  a  total  of  672  syphilitic  women  who  have  come  under 
my  observation  in  my  private  practice,  I  found  no  fewer 
than  81  who  contracted  syphilis /rom  their  husbands  soon 
after  marriage.  These  figures  are  sufficiently  eloquent 
by  themselves  to  render  all  commentary  unnecessary. 
Let  this  be  a  warning,  then,  to  families  who  consider  not 
the  health  of  their  future  sons-in-law,  and  who  neglect  to 
protect  their  daughters  against  careless,  indifferent,  or  un- 
principled men,  to  whom  it  is  a  matter  of  little  concern  to 
carry  the  pox  into  the  conjugal  bed. 

This  fact,  then,  is  patent :  frequently  young  married 
women  receive  syphilis  from  their  husbands.  TMs  fact 
we  must  now  explain. 

How  do  wives  in  such  circumstances  receive  syphilis 
from  their  husbands  ?  How  does  a  syphilitic  husband  be- 
come dangerous  to  his  wife  ?  How,  in  a  word,  is  the  syph- 
ilitic contagion  transmitted  from  the  husband  to  the  wife  ? 


18  SYPHILIS  AND  MARRIAGE. 

In  two  ways,  one  of  wMcli  is  very  simi)le,  trite,  and 
commonplace,  and  tlie  other  is  sj)ecial,  mysterious,  not 
materially  demonstrable,  but  wMcli  is  undeniable,  as  has 
been  demonstrated  by  observation.  To  explain  this,  cer- 
tain preliminary  statements  are  necessary. 

The  first  mode  of  contagion,  which  I  have  just  now 
characterized  as  the  common,  ordinary  one,  consists  simply 
in  this :  Transmission  to  the  wife  of  a  contagious  lesion 
occurring  in  the  husband  after  marriage. 

A  syphilitic  husband  not  yet  cured  of  his  syphilis 
comes  to  be  affected  with  a  supjDurative  lesion  of  a  specific 
nature.  He  has  connection  with  his  wife  at  this  time. 
IS'aturally,  he  infects  this  wife  from  the  lesion  which  he 
actually  has  at  the  time.  There  is  nothing  but  what  is 
very  simple,  nothing  but  what  is  absolutely  normal  in 
this  mode  of  contagion,  which  is,  as  every  one  knows, 
the  ordinary  mode  by  which  syphilis  is  transmitted,  prop- 
agated, and  maintained. 

As  examples  of  this  kind :  A  young  man  marries  after 
fifteen  months  of  syphilis.  He  comes  to  have  on  his  glans 
two  circinate  erosions  of  the  kind  which  we  term  in  tech- 
nical language  papulo-erosive  syphilides  of  annular  form. 
Regarding  these  lesions  as  herpes  (another  affection  to 
which  he  is  subject  at  times),  he  continues  to  have  inter- 
course with  his  wife,  and  thus  communicates  syphilis  to 
her,  Avhich  makes  its  debut  by  an  indurated  chancre  on  the 
vulva,  soon  followed  by  general  symptoms. 

Another  young  man,  belonging  to  the  highest  social 
circles,*  marries  despite  my  advice,  after  two  years  of 

*  I  note  by  design  this  particularity,  as  I  shall  again  note  it  if  occasion  serve. 
And,  in  fact,  numbers  of  persons  imagine  and  repeat  that  transmissions  of  syphilis 
in  marriage  are  scarcely  ever  met  with  except  "  among  the  lowest  classes,"  and  as 
a  result  of  ignorance,  of  carelessness,  of  misery,  etc.  Now,  this  is  a  delusion,  a 
grave  error,  against  which  daily  experience  protests.     The  cases  of  this  character 


DANGERS  DUE  TO  SYPHILIS  IN  MARRIAGE.  19 

syphilis.  A  great  smoker,  lie  is  often  affected  with  slight 
labial  erosions,  to  which  he  pays  no  attention,  Notwith- 
standing my  advice,  he  obstinately  refuses  to  consider 
them  dangerous  or  to  have  them  treated.  Consequence : 
From  one  of  these  erosions,  which  I  had  regarded  as  un- 
doubtedly syphilitic,  he  eventually  transmits  syphilis  to 
his  wife,  upon  whom  I  afterward  discover  an  indurated 
chancre  of  the  lower  lip. 

One  of  my  professional  friends  contracts  syphilis.  He 
treats  himself.  Thinking  himself  cured,  three  years  later 
he  marries.  Some  months  afterward  I  receive  a  despond- 
ing letter  from  him.  "A  lamentable  catastrophe,"  he 
writes,  "has  befallen  me.  Quite  recently  I  have  had  the 
misfortune  to  infect  my  young  wife,  nineteen  years  old ; 
and  I  have  infected  her — it  is  not  to  be  believed — ^with  a 
miserable  little  papule  on  the  penis,  an  erosive  papule,  it 
is  true,  but  minute,  absolutely  minute  to  the  degree  that 
I  did  not  at  first  perceive  it,  and  afterward  took  no  pre- 
caution!" 

And,  in  like  manner,  gentlemen,  I  could  accumulate 
here  many  other  cases  of  the  same  character,  differing  per- 
haps in  detail,  but  all  identical  in  nature.  This  first  mode 
of  contagion,  I  repeat,  is  frequent,  then,  even  in  marriage. 
And  how  could  it  be  otherwise,  considering  the  extreme 
contagiousness  of  the  suppurative  form  of  secondary  acci- 
dents— considering  the  repeated  developments,  so  frequent 
and  so  easy,  of  accidents  of  this  order  in  syphilitic  sub- 
jects imperfectly  treated — considering  the  multiplicity  of 

are  encountered  almost  equally  in  all  classes,  from  the  humblest  to  the  most  ex- 
alted. I  declare,  for  my  part,  that  I  have  observed  a  great  number  in  the  higher 
bourgeoisie,  even  among  the  aristocracy — that  is  to  say,  in  social  surroundings 
where  education,  intellectual  and  moral  culture,  absence  of  pecuniary  cares,  per- 
sonal independence,  the  free  gratification  of  the  desires,  etc.,  etc.,  ought,  it  would 
seem,  to  exclude  such  shames. 


20  SYPHILIS  AND  MARRIAGE. 

the  relations,  familiarities,  and  contacts  of  every  kind 
wMcli,  in  domestic  and  family  life,  expose  the  wife  to  in- 
fection from  her  husband  ? 

The  last  consideration  which  I  have  just  mentioned  is 
of  the  first  importance,  and  I  beg  you  to  remark  it.  Con- 
tagion, in  fact,  is  rendered  so  easy  by  the  close  and  con- 
tinual intimacy  which  results  from  marriage,  that  it  be- 
comes almost  inevitable.  According  to  exx)erience,  it.  is 
rare  to  see  a  healthy  woman  live  long  in  contact  with  a 
syphilitic  man  (or  inversely,  but  the  converse  does  not  in- 
terest us  just  now)  without  the  healthy  partner  becoming 
contaminated  by  the  diseased  partner.  As  that  witty  ob- 
server, M.  Dechambre, has  said :  "The  pox,  like  the  daily 
bread,  is  divided  between  husband  and  wife." 


CHAPTER  III. 

SYPHILIS   BY   COI^CEPTION. 

The  second  mode  in  wMcli  sypMlitic  contagion  oper- 
ates in  marriage  is  entirely  different  from  the  preced- 
ing, and  absolutely  special,  as  you  will  see.  It  consists 
in  wliat  is  called  syphilis  hy  conception.  Little  known  or 
at  least  little  believed  in  by  us,  denied  even  by  many  of 
the  profession,  this  syphilis  by  conception  ought  to  receive 
here  some  consideration,  for  it  constitutes  a  part,  and  a 
very  essential  part,  of  our  subject."^ 

How  does  it  present  itself  in  practice  ?  How  does  it 
manifest  itself  to  observation  ?  As  follows :  A  pure  and 
healthy  young  woman  is  married  to  a  syphilitic  man, 
whose  syphilis  is  not  yet  eradicated.  Summoned  to  attend 
her  some  months  later,  you  find  her  syphilitic  ;  you  find 
her,  for  example,  affected  with  unmistakable  secondary 
symptoms,  such  as  the  cutaneous  syphilides,  buccal  mu- 
cous patches,  acneiform  crusts  of  the  hairy  scalp,  cervical 
adenopathies,  pains  in  the  head,  wandering  neuralgias, 
lumbago,  intermittent  febrile  attacks,  alopecia,  etc.  There 
is  no  doubt  possible :  this  woman  is  thoroughly  syphilitic. 
This  settled,  you  proceed  to  investigate  the  why  and 

*  If  I  did  not  treat  this  question  in  a  manner  exclusively  incidental,  I  should 
cite  here  the  opinions  and  the  well-known  works  of  MM.  Depaul,  Diday,  Hutchin- 
son, de  Meric,  Melchior  Robert,  Bazin,  etc. 
3 


22  SYPHILIS  AND  MARRIAGE. 

wherefore  of  tliis  sypMlis.  How  did  syphilis  attack  this 
young  wife  ;  in  what  way  was  it  introduced  ;  what  was  the 
initial  accident;  where  was  the  seat  of  the  chancre,  etc.? 
And,  now,  a  double  astonishment  begins  for  you.  There 
is,  in  the  first  place,  no  trace  of  what  is  called  the  primary 
affection,  no  vestige  of  a  chancre,  no  recollection  of  a 
localized  lesion  having  preceded  the  present  symptoms  by 
several  weeks.  "  Pass  over  the  chancre,"  you  say  to  your- 
self, "for  every  one  knows  that  in  the  female  the  chancre 
is  often  but  a  slight,  fugitive  lesion,  which  may  easily  pass 
unperceived  by  the  patient,  and  can  not,  after  a  very  short 
time,  be  detected  by  the  physician.  But,  at  least,  I  shall 
find  a  bubo,  for  the  bubo  is  not  only  the  '  faithful  compan- 
ion of  chancre,'  according  to  M.  Ricord,  but  also  a  post- 
Tiumous  witness  that  long  survives  it — that  testifies  to  its 
previous  existence  long  after  its  disappearance  and  cica- 
trization." You  then  search  for  the  bubo,  and  you  do  not 
find  it  either.  There  is  no  trace  anywhere  of  a  primitive 
adenopathy.  In  a  word,  there  is  nothing  but  secondary 
accidents,  as  if  the  syphilis  had  manifested  itself  cTemblee 
in  this  patient — as  if  it  had  never  had  a  primary  stage.  At 
the  first  blush,  this  seems  very  strange,  does  it  not  ?  But 
this  is  not  aU.  Another  surprise  immediately  awaits  you. 
Syphilis  thus  verified  in  the  young  wife,  you  take  the 
husband  aside,  who  confesses  his  syphilitic  antecedents  to 
you,  if  you  are  not  aheady  aware  of  the  fact.  Then  you 
naturally  ask  him  what/re^/^  accidents  he  has  experi- 
enced since  his  marriage  which  could  infect  his  wife.  Upon 
this,  protestations,  strong  protestations,  on  the  part  of 
your  patient !  "  ISTo  ;  I  teU  you  I  have  had  no  new  symp- 
toms since  my  marriage  ;  nothing,  absolutely  nothing.  I 
was  aware  of  my  condition.  I  had  been  warned  by  my 
physician  of  the  dangers  which  my  wife  would  incur  if 


8YPEILI8  BY  CONCEPTION.  23 

there  should  happen  to  me  any  accident  similar  to  those  I 
had  already  had.  I  have  been  on  my  guard,  I  have  ex- 
amined myself,  I  have  watched  myself  scrupulously,  and 
I  can  afS.rm  to  you  in  the  most  positive  manner  that  no- 
thing suspicious  has  appeared  upon  me  since  the.  day  of 
my  marriage.     That  I  will  answer  for." 

Not  content  with  these  assertions,  you  proceed  to  make 
a  careful  examination  of  your  patient ;  the  result  of  the 
examination  is  negative.  Not  the  least  evidence  of  the 
disease  is  present  either  upon  the  skin  or  upon  the  mu- 
cous surfaces — ^not  the  least  trace  of  a  lesion  recently  van- 
ished. So  that,  judging  from  appearances,  one  is  forced 
to  admit  this  :  that  the  young  wife  has  become  syphilitic 
from  the  contact  of  her  syphilitic  husband,  without  the 
husband  having  at  the  time  the  least  external  lesion  ca- 
pable of  infecting  her.^ 

Without  doubt,  gentlemen,  if  cases  of  this  kind  were 
observed  only  once,  perchance  in  a  manner  altogether  ex- 
ceptional, one  would  have  the  right,  strictly,  to  call  them 
in  question,  to  reject  them,  and  to  say :  "These  cases  are 
null  and  void,  incomplete,  defective.  These  are  cases 
where  there  has  been  a  mistake,  either  on  the  part  of  the 
woman,  who  has  not  seen  or  felt  the  chancre,  or  on  the 
part  of  the  husband,  who  deceives  himself  or  who  deceives 
us.  Let  us  pass  them,  then,  without  attaching  any  impor- 
tance to  them."  But  the  truth  is,  on  the  .contrary,  that 
cases  of  this  kind  are  common  ;  they  are  frequent ;  they 

*  I  do  not  bring  into  discussion  here  tlie  possibility  of  a  contagion  by  the 
sperm.  From  ancient  date  it  has  been  established  by  clinical  observation  that  the 
sperm  of  a  syphilitic  subject  is  not  susceptible  of  transmitting  the  contagion. 
Experimentation  has  recently  pronounced  itself  in  the  same  sense.  Healthy  sub- 
jects have  been  inoculated  with  sperm  derived  from  syphilitic  subjects,  and,  as 
might  have  been  expected,  the  inoculation  has  been  without  result. — (V.  Mireur,  He- 
cherches  sur  la  non-inoculabilite  sypliilitique  au  sperme,  publiees  dans  les  Annales  de 
dermat.  et  sypldlic/.,  t.  viii,  p.  423  ;  Dr.  X.,  oral  communication. 


24  SYPHILIS  AND  MARRIAGE. 

obtrude  themselves  upon  our  observation  with  a  significant 
persistence ;  they  present  themselves  always  identically 
the  same,  always  under  the  same  conditions  ;  finally,  they 
force  themselves  upon  us  at  times,  carrying  conviction 
with  them. 

In  reality,  this  is  not  a  class  of  cases  that  can  be  ig- 
nored, or  in  which  it  can  be  objected  that  we  have  to  do 
with  a  negligent  husband,  unconscious  of  danger,  careless 
of  his  person — a  poor  observer,  liable  to  allow  a  specific 
accident  upon  himself  to  pass  unperceived.  These  are 
cases  of  an  entirely  different  character,  which  have  been 
recorded  of  husbands  very  attentive  to  the  state  of  their 
health,  scru]3ulous,  conscientious,  apprised  of  the  dangers 
to  which  their  wives  are  exposed  from  their  old  diathesis, 
and  who  never  cease  to  examine  themselves  with  the  most 
minute  care.  There  are  cases  of  this  kind,  finally,  which 
have  been  observed  by  physicians  in  projjrid  persona,  in 
their  own  families.  I  know  of  many  of  them  which,  un- 
fortunately, I  am  not  privileged  to  cite.'^' 

Now,  when  these  husbands,  who  so  intelligently  appre- 
ciate their  condition,  when  these  professional  men  repeat 
to  our  satisfaction:  "No,  I  assure  you,  I  have  not  had 
any  symptom  since  my  marriage  ;  I  have  not  had,  either 
on  the  penis,  or  in  the  mouth,  or  elsewhere,  the  smallest 
erosion,  the  least  scratch,  the  slightest  abrasion  capable  of 
infecting  my  wife" — when  from  such  assertions  we  are 
furnished  with  such  guarantees,  and  when  these  assertions 
are  reproduced  identically  parallel,  not  only  in  a  few  cases, 
but  in  a  multitude  of  cases  of  the  same  kind — when  a  fact 
so  inexplicable,  so  extraordinary,  as  this  may  appear,  be- 
comes no  longer  the  exception,  but  the  common,  habitual, 
almost  general  rule — under  such  circumstances  we  are 

*  Cf.  J.  Hutchinson,  "  Medical  Times  and  Gazette,"  December,  1876,  p.  643. 


SYPHILIS  BY  GONGEPTIOK  '     25 

forced  to  yield,  to  surrender  an  incredulity,  otherwise 
quite  legitimate,  and  to  conclude,  finally:  "It  must  be 
so  ;  here  is  a  woman  who,  on  the  one  hand,  has  the  syph- 
ilis witliout  Jiamng  presented  an  initial  lesion,  and  who, 
on  the  other  hand,  has  been  infected  by  her  husband  witli- 
out the  Jiushand presenting  any  contagious  lesion.''''  But, 
then,  what  is  this  mystery  ? 

What,  then,  is  this  mystery  ?  Well,  gentlemen,  here  is 
the  key :  That  the  woman  become  syphilitic  in  this  man- 
ner without  initial  lesion,  without  chancre,  and  become 
syphilitic  from  the  contact  of  a  husband  exempt  since  his 
marriage  from  every  contagious  lesion  —  that  woman  is 
enceinte,  and  she  has  received  the  syphilis  by  conception. 

In  cases  of  this  kind,  gentlemen,  there  is  always  a 
special  element  which  intervenes  to  complicate  the  morbid 
ensemble  ;  and  this  new,  this  supernumerary  element  (per- 
mit me  the  word)  is  pregnancy.  In  such  a  situation,  preg- 
nancy is  never  absent.  If  It  happens  to  you  (and  it  will 
happen  many  times  in  your  practice)  to  encounter  a  wo- 
man who  has  acquked  syphilis  without  presenting  pri- 
mary accidents,  and,  moreover,  has  acquired  syphilis  from 
a  syphilitic  companion  who  has  for  a  long  time  been  free 
from  every  suspicious  symptom,  direct  your  attention  al- 
v/ays  to  the  question  of  pregnancy ;  interrogate,  examine 
the  woman  from  this  point  of  view,  and  invariably  you 
will  succeed  in  establishing  this :  either  this  woman  is 
actually  enceinte  at  the  moment  of  your  visit  or  she  has 
been  recently  enceinte,  and  has  just  been  confined,  or  she 
has  had  a  miscarriage. 

Ah,  then,  if  this  be  the  case,  if  always,  and  invariably, 
the  facts  which  we  are  now  studying  present  themselves 
thus,  with  the  necessary  addition  of  a  special  element, 
pregnancy,  this  fact  becomes  a  ray  of  light  for  us. 


26  SYPHILIS  AND  MARRIAGE. 

Since  these  cases  which  deviate  from  the  normal  laws 
of  syphilitic  contagion  are  always  complicated  by  a  special 
element,  which  intervenes  in  a  constant  manner,  may  not 
this  element  prove  to  be  the  cause  of  the  said  anomaly  ? 
May  not  pregnancy  play  a  role  here  in  deteiTiiining  this 
apparent  modification  of  the  usual  modes  of  contagion? 
May  not  this  woman,  who  appears  to  have  contracted  the 
syphilis  from  her  husband,  in  reality  have  received  it 
from  her  child — from  the  infant  which  sojourned  in  the 
maternal  womb — with  the  syphilis  which  it  received  from 
its  father  1 

Indeed,  yes,  gentlemen,  and  such,  there  can  be  no 
doubt,  is  the  origin  of  the  syphilis  in  the  cases  in  ques- 
tion. The  wife-mother,  infected  thus,  that  is,  become 
syphilitic  without  initial  accident,  and  become  syphilitic 
from  the*  contact  of  a  husband  long  free  from  every  exter- 
nal manifestation,  has  received  the  syphilis,  not  from  her 
husband,  hut  from  Tier  child. 

We  have  not  here  a  syphilis  transmitted  by  contagion 
in  the  usual,  habitual  manner :  there  is  here  a  syphilis 
conceived  in  utero,  introduced  by  the  infant  into  the 
womb  of  its  mother,  communicated  to  the  mother  by  her 
infant — in  a  word,  it  is  what  is  teimed  syphilis  by  con- 

CEPTIOjN^. 

It  would  be  foreign  to  my  subject  to  enter  here  into 
the  clinical  history  of  syphilis  by  conception,  so  differ- 
ent from  ordinary  syphilis  both  in  its  origin  and  in  its 
primordial  evolution ;  but  it  is  im]Dortant  that  I  leave 
you  in  no  doubt  as  to  its  authenticity,  and  with  this  view 
I  add  the  following  considerations  : 

1,  In  the  first  place,  if  we  reject  this  pathogeny  of  the 
infection  transmitted  to  the  mother  by  the  foetus  in  the 
class  of  cases  which  we  are  now  considering,  viz.,  the 


S7PEILIS  BY  CONCEPTION.  27 

syphilis  of  young  wives  who  never  present  the  primary 
accident,  chancre,  and  who  receive,  or  seem  to  receive, 
the  contagion  from  a  non-contagious  husband — this  syph- 
ilis, I  say,  will  remain  absolutely  incomprehensible,  abso- 
lutely inexplicable. 

And  I  repeat  this  again :  the  cases  of  this  kind  are 
too  numerous,  too  well  authenticated  for  us  to  refuse  to 
receive  them,  for  us  to  think  of  interpreting  them  by 
assuming  material  errors  of  observation.  They  actually 
obtrude  themselves  in  practice,  and  it  is  necessary  to 
recognize  them  as  facts  without  discussing  the  theory. 

2.  These  same  cases,  which  deviate  from  the  general 
laws  of  ordinary  syphilis,  never  thus  deviate  except  with 
the  addition  of  a  special  element,  which  is  none  other 
than  pregnancy.  Always  and  invariably  they  occur  in 
women  enceinte  or  recently  confined.  Is  not  this  signifi- 
cant? Does  it  not  imply  that  pregnancy  plays  here  a 
special  role  in  modifying  the  usual  conditions  of  syphi- 
litic contamination  ? 

There  are,  moreover,  certain  facts  more  conclusive 
still,  if  possible.  These  facts  may  be  summarized  thus  : 
A  healthy  woman  is  united  to  a  syphilitic  man.  So  long 
as  she  does  not  become  pregnant,  she  remains  uncontam- 
inated ;  but  let  her  become  pregnant,  and,  immediately, 
syphilis  breaks  out  upon  her. 

Now,  why  this  immunity  before  pregnancy,  and  why 
this  infection  taking  place  with  pregnancy,  if  conception 
be  immaterial,  if  it  have  no  part  ia  the  specific  contamina- 
tion.* 

3.  A  third  argument  arises  from  the  morbid  condition 
of  the  infant.     I  will  explain  what  happens  to  the  infant 

*  Cases  of  this  order  have  been  signalized  already  by  numbers  of  physicians. 
I  confine  myself  to  announcing  the  fact  without  citing  particular  examples. 


28-  SYPHILIS  AND  MARRIAGE. 

in  tMs  class  of  cases  of  wliich  we  are  now  si)eaking. 
Most  commonly,  in  truth,  it  dies  before  being  born.  Was 
it  or  was  it  not  syx)liilitic  ?  We  know  nothing  positively 
upon  this  point,  and  we  have  nothing  to  say,  although  the 
sole  fact  of  its  death  constitutes  a  presumption  in  favor  of 
syphilis.  But  in  other  cases  it  is  bom  alive,  and  then  it 
always  manifests  unequivocal  symptoms  of  syphilis  ;  it  is 
ahoays  sy]?liilitic.  Now,  if  the  infant  in  such  circum- 
stances is  tainted  with  syphilis,  what  is  there  impossible 
or  extraordinary  in  its  transmitting  the  disease  to  the 
mother  during  its  intra-uterine  life  ? 

If  maternal  syi^hilis  has  the  power  (which  every 
one  admits)  of  reflecting  itself  upon  the  infant,  why 
should  not  the  syphilis  of  the  infant  reflect  itself  in  like 
manner  upon  the  mother?  What!  Here  is  an  infant 
which,  i)rocreated  syphilitic  by  the  agency  of  its  father, 
lives  syphilitic  during  several  months  in  the  womb  of  its 
mother,  and  yet  you  would  think  it  extraordinary,  impos- 
sible, that  the  infection  of  the  infant  should  be  trans- 
mitted to  the  mother!  A  syphilitic  organism  included 
within  a  healthy  organism,  and  the  one  not  contaminate 
the  other  !  In  truth,  it  is  not  the  infection  of  the  mother 
under  such  conditions  which  would  in  my  estimation  con- 
stitute the  surprising  fact ;  for  me,  the  surprising  fact 
would  be  that  the  mother  remained  refi'actory  to  such 
chances  of  contagion. 

4.  After  all,  syj)hilis  by  conception  is  but  the  analogue 
of  the  syphilis  which,  in  the  course  of  pregnancy,  reflects 
itself  in  an  opposite  direction,  from  the  mother  to  the  in- 
fant. It  is  necessary,  then — common  sense  indicates  it — 
that  it  obey  the  same  laws  as  the  latter,  and  this  is  precisely 
what  takes  place,  as  you  will  see. 

The  peculiarity  of  hereditary  syphilis,  you  know,  is  to 


SYPHILIS  BY  CONGEPTIOK  29 

make  an  invasion  WemMee  by  general  symptoms ;  that  is, 
to  have  no  primary  stage,  in  a  word,  to  be  exempt  from 
those  two  accidents  which  constitute  the  inevitable,  neces- 
sary debut  of  every  syphilis  contracted  in  the  usual  way 
of  contagion,  ^iz.,  chancre  and  primitive  adenopathy 
symptomatic  of  chancre.  JSTow,  the  syphilis  of  concep- 
tion has  precisely  the  same  peculiarity.  It  also  ad- 
mits neither  chancre  nor  bubo  into  the  number  of  its 
constituent  symptoms.  It  also  makes  invasion  cfemhlee 
by  manifestations  of  a  general  order,  and  this  devia- 
tion from  the  great  laws  which  govern  syphilis  in  its 
habitual  forms  certainly  finds  its  analogue  in  the  special 
mode  which  here  presides  over  infection. 

Such  are,  in  a  very  succinct  form  to  be  sure,  but  suffi- 
cient I  think  for  our  present  subject,  the  considerations  of 
various  kinds  which  establish  the  undeniable  fact  of  the 
possible  infection  of  a  woman  by  way  of  conception. 
The  fact  admitted  and  accepted,  it  now  remains  for  us  to 
discuss  its  interpretation,  if  this  does  not  exceed  the  limits 
withia  which  we  must  confine  ourselves.  How  does  syph- 
ilitic impregnation  irradiate  from  the  foetus  to  the  mother 
in  the  cases  we  have  just  considered  \  Does  the  maternal 
infection  result  from  the  contact  of  a  fecundated  ovule, 
and  propagate  itself,  either  in  the  Fallopian  tubes  or  in 
the  uterus,  at  the  time  when  this  ovule  is  not  attached  to 
the  mother  by  any  organized  graft  ?  Or,  indeed,  is  it  ef- 
fected subsequently  by  the  exchanges  of  the  placental 
circulation  ?  *  or  does  it  take  place  in  some  other  special 
and  unknown  manner  ?  Upon  this  point  we  confess  our 
complete  ignorance.     We  know  nothing  of  the  process,  of 


*  This  is  what,  for  example,  M.  J.  Hutchinson  declares,  who  has  given  to  this 
mode  of  infection  of  the  mother  by  the  infant  the  expressive  term  of  fatal  blood 
contamination. — V.  Memoir  cited,  "Medical  Times  and  Gazette,"  18*76. 


30  SYPHILIS  AND  MARRIAGE. 

the  meclianism  of  the  infection,  and,  relative  to  tMs  point, 
we  can  only  emit  hypotheses  without  value.  Infection 
takes  place  only  in  these  special  conditions,  and  often, 
very  often,  the  wives  are  the  victims.  The  knowledge  of 
this  alone  is  sufficient  for  our  present  purpose.  Let  us, 
then,  accei')t  the  fact,  and  leave  the  interpretation  aside. 

This  settled,  let  us  reunite  the  elements  which  pre- 
cede, and  summarize  the  facts  relating  to  our  first  propo- 
sition, by  saying :  A  man  with  syphilitic  antecedents  who 
contracts  marriage  may  become  dangerous  to  his  wife  in 
two  ways : 

1.  Directly  by  transmissible  contagious  lesions,  which 
may  ha^Dpen  to  him  after  marriage. 

2.  Lidirectly,  ihMOTigkYns,  fecundating  power  ;  that  is, 
by  the  procreation  of  an  infant,  the  infection  of  which 
may  he  reflected  upon  the  mother. 


CHAPTEE  IV. 

PATERNAL     HEEEDITY. 

Second  Point.  —  A  man  witli  sypMlitic  antecedents 
who  contracts  marriage  may  hecome  dangerous  to  Ms 
cMldren. 

1.  Until  within  a  recent  period,  the  theory  of  the  pater- 
nal heredity  of  syphilis  was  accepted  without  opposition, 
except  from  a  few.  It  was  not  questioned  that  a  syph- 
ilitic father  could,  must  even,  beget  syphilitic  children. 
It  was  an  opinion  generally  admitted,  and  science  seemed 
definitely  settled  upon  this  point. 

But  the  aspect  of  this  question  has  Indeed  changed 
within  late  years  :  numerous  observations,  important  in- 
vestigations, have  sprung  up  on  aU  sides,  tending  to  sin- 
gularly restrict  the  sphere  of  paternal  influence  in  the 
hereditary  transmission  of  syphilis.*  But  this  is  not  aU ; 
some  investigators  have  gone  further  in  this  direction. 

*  CuUerier,  De  Vheredite  de  la  syphilis. — Memoires  de  la  societe  de  chirurgie  de 
Paris,  1851,  t.  ir,  p.  230. 

Notta,  Memoire  sur  VMredite  de  la  syphilis. — Archives  generales  de  medecine, 
1860,  t.  i. 

Charrier,  De  VMr&dite  syphiliiique. — Archives  generales  de  medecirie,  1862,  t.  ii. 

Durac  (J.  E.),  Be  Vheredite  de  la  syphilis. —  Theses  de  Montpelier,  1866. 

Mireur  (H.),  Essaisur  Vheredite  de  la  syphilis. — TTieses  de  Paris,  1Q&1. 

Owre  (Adam),  8w  Vetiologie  de  la  syphilis  hereditaire. — Analyse  dans  les  An- 
nales  de  dermatologie  et  de  syphiligraphie,  t.  v,  p.  388. 

Sturgis  (F.  R.),  "Notes  upon  Certain  Points  of  the  Etiology  of  Hereditary 
Syphilis." — Analysis  in  Annales  de  dermatologie  et  de  syphiligraphie,  1877,  t.  ix, 
p.  113. 


32  SYPHILIS  AND  MARRIAGE. 

They  hiave  gone  to  tlie  point  of  denying  the  paternal  influ- 
ence in  the  transmission  of  the  disease,  and  of  saying: 
"The  influence  of  the  father  is  null,  absolutely  null,  in 
the  ti^ansmission  of  syphilis  to  the  foetus.  The  child  of  a 
syphilitic  man  is  born  sound,  exempt  from  syphilis,  and 
perfectly  healthy." 

You  can  conceive,  gentlemen,  the  importance  of  this 
question  in  connection  with  the  special  subject  which  now 
engages  our  attention.  For,  when  a  syx)hilitic  patient 
comes  to  consult  us  in  order  to  know  whether  he  may  or 
may  not  marry,  our  responsibility  will  be  by  so  much 
lightened,  if  we  have  before  us  the  certainty  that  this 
man,  although  syphilitic,  can  in  no  way  be  prejudicial  to 
his  children.  That  is  self-evident.  Let  us  examine  this 
question,  then,  with  all  the  care,  all  the  solicitude  which 
it  merits.  The  new  doctrines  which  have  been  introduced 
relative  to  the  non-transmission  of  syphilis  by  paternal 
heredity,  or,  more  generally,  the  non-influence  of  paternal 
syphilis  upon  the  offspring — these  new  doctrines,  I  say, 
while  containing  an  element  of  truth,  contain  manifest  ex- 
aggerations, and  more  than  exaggerations,  absolute  errors, 
dangerous  from  a  social  point  of  view,  dangerous  in  every 
respect,  and  which,  in  consequence,  should  be  energeti- 
cally combated.  For  my  part,  indeed,  according  to  my 
own  experience,  as  well  as  from  numerous  observations 
which  have  been  furnished  either  from  my  reading  or 
from  communications  courteously  made  to  me,  I  regard 
it  as  certain  that  a  syphilitic  father  can,  by  vh^tue  of 
a  syphilis  still  recent  and  active,  be  eminently  preju- 
dicial to  his  children.  And  of  this  I  am  in  a  position  to 
furnish  the  proofs,  as  you  shall  see. 

In  the  first  place,  to  consider  the  matter  from  a  purely 
theoretical  point  of  view,  how  can  we  admit,  for  a  single 


PATERNAL  HEREDITY.  33 

instant,  that  the  condition  of  a  syphilitic  father  can  be 
inoffensive  to  his  offspring  ?  What !  when  we  see  con- 
stantly, and  in  a  manner  so  evident,  paternal  heredity 
manifest  itself  in  the  child  by  so  many  resemblances  of 
every  kind ;  when  we  see  it  attested,  not  only  by  physical 
or  moral  analogies,  bnt  also  by  the  most  striking  patho- 
logical analogies,  we  are  to  believe  that  this  paternal 
heredity  may  not  be  exerted  in  the  case  of  an  essentially 
chronic,  essentially  diathetic  disease,  impregnating  the 
organism  so  profoundly  as  to  have  the  twofold  property 
of  affecting  the  whole  system,  and  of  developing  its  mani- 
festations at  all  periods  and  all  intervals,  up  to  thirty, 
forty,  and  fifty  years  after  its  origin  !  We  are  to  regard 
a  disease  of  this  character  as  inactive,  hereditarily,  from 
the  father  to  the  chUd  !  If  this  were  the  case,  it  would  be, 
in  truth,  an  anomaly  most  strange,  a  monstrous  departure 
from  all  that  we  know  concerning  the  general  laws  of 
heredity. 

The  syphilis  of  the  father  is  not  inoffensive  to  the  prod- 
uct of  conception :  this  is  what  theory  presupposes  ;  this 
is  what  a  legitimate  induction,  based  upon  the  elements 
of  common  observation,  leads  to. 

But,  in  considering  a  question  at  once  so  serious  and 
difficult  as  this,  we  should  not  be  satisfied  with  compari- 
sons, indirect  inductions,  a  priori  reasonings.  It  is  facts, 
and  precise  facts,  which  we  must  have.  Let  us  consult, 
then,  clinical  observation,  and  see  what  it  teaches  us. 

We  commence  by  stating  the  position  as  strongly  as 
possible  (regretting  our  inability  to  make  it  stronger  still) 
of  the  partisans  of  the  doctrine  that  we  are  about  to  op- 
pose, and  say  with  them  :  Yes,  it  is  true,  absolutely  true, 
tJiat  we  encounter  in  practice  nunibers  of  men,  loho,  liais- 
ing contracted  sypliilis  before  their  marriage,  ham  be- 


34  SYPHILIS  AND  MARRIAGE. 

gotten  children  healthy  and  exempt  from  syphilis,  their 
wives  tliemselxies  remaining  healthy  and  uninfected. 

Examples  of  tliis  kind  are  observed  every  day  in  pri- 
vate practice.  MM,  E-icord,  Cullerier,  Notta,  Charrier, 
Durac,  Mireur,  and  many  otliers  that  I  need  not  mention, 
liave  related  cases  of  this  character  as  authentic  and  con- 
vincing as  possible.  My  own  personal  observation  accords 
fully  with  that  of  the  authors  I  have  Just  cited,  and  I  find 
in  my  notes  (to  speak  only  of  the  cases  coming  under  my 
immediate  observation)  eighty- seven  cases  in  which  syph- 
ilitic fathers  married  to  healthy  women,  who  remained 
healthy,  have  had  healthy  children,  absolutely  exempt 
from  every  syphilitic  manifestation,  from  every  suspicious 
symptom.* 

I  am  reluctant  to  relate  individual  cases  here,  so  fre- 
quent and  common  are  they.  Nevertheless,  there  are  so 
many  cases  observed  in  which  the  non-influence  of  the 
father's  disease  upon  the  child  is  sho^vn  in  a  manner  so 
manifest,  so  striking,  that  you  will  pardon  me  for  citing 
some  of  them,  in  order  to  establish  your  convictions  more 
thoroughly  upon  this  point. 

A  patient  of  our  distinguished  confrere,  M.  Charrier, 
had  been  affected  with  syphilis  for  several  years,  when  he 
became  the  father,  exactly  at  the  same  date,  of  two  chil- 
dren, viz.,  one  born  of  his  wife,  to  whom  he  had  com- 
municated syphilis,  the  other  born  of  a  mistress,  exempt 
from  every  specific  antecedent.  Now  what  happened? 
This:  Of  these  two  children,  one,  the  legitimate  child, 
came  into  the  world  with  syphilis  ;  the  other,  the  natural 
child,  was  born  healthy,  and  remained  so.f 

*  V.  Illustrative  Cases,  Note  1. 

f  Charrier,  De  Vhered'de  syphilitique. — Archives  generales  de  medecine,  1862,  t, 
ii,  p.  327. 


PATERNAL  HEREDITY.  35 

The  natural  and  irresistible  conclusion  is,  that,  when 
the  mother  is  healthy,  the  syphilitic  influence  of  the 
father  upon  the  product  of  conception  is  null. 

Another  example,  furnished  by  M.  MireUr :  A  man 
marries  after  eleven  months  of  syphilis,  and  becomes  the 
father  of  a  fine  child,  absolutely  healthy  (the  mother  re- 
maining still  uncontaminated).  ISTow,  this  child  was  so 
healthy,  he  was  so  little  tainted  with  the  least  syphilitic 
vice,  that  at  the  age  of  two  years  he  contracted  syphilis, 
and  from  whom  %  From  his  father !  The  father  had  a 
secondary  erosion  in  his  mouth  ;  he  kissed  his  child  upon 
the  mouth,  and  in  this  way  communicated  to  him  a 
chancre  of  the  Up.* 

But  there  are  two  classes  of  facts  more  confirmatory 
still,  as  they  embrace  an  additional,  supernumerary  ele- 
ment, viz.,  the  breaking  out  of  syphilitic  accidents  upon 
the  father,  either  subsequently  to  the  date  of  conception 
or  even  at  the  moment  of  conception.  And,  nevertheless, 
children  born  in  such  conditions  have  escaped  syphilitic 
heredity,  although  the  paternal  affection  was  still  mani- 
festly persistent,  or  even  exhibited  actual  symptoms,  at 
the  time  of  procreation.     I  will  explain : 

I.  It  is  a  matter  of  frequent  occurrence  for  syphilitic 
men  to  beget  healthy  children,  and  afterward  present 
such  and  such  accidents  of  syphilis,  unequivocal  evidences 
of  the  persistence  of  the  diathesis  at  the  time  when  con- 
ception takes  place. 

Example  :  One  of  my  patients,  syphilitic  for  ten  years, 
married  while  exempt  from  every  apparent  diathetic 
phenomenon,  and  became  the  father  of  six  children. 
These  six  children,  of  whom  the  eldest  is  at  present  eleven 
years  of  age,  I  have  had  under  my  observation  since 

*  Tlike  dtee,  p.  26. 


36  SYPHILIS  AND  MARRIAGE. 

their  bii'tli ;  I  have  attended  them  in  all  their  indis- 
positions, even  the  slightest,  and  I  am  justified  in  declar- 
ing them  absolutely  healthy.  Their  mother,  moreover, 
has  never  jDresented  the  least  suspicious  symi3tom.  Now, 
after  the  Mrth  of  tlie  third  cliild,  this  man  was  affected 
with  a  tubercular  syphilide  upon  the  thorax;  and,  in 
addition,  consecuthely  to  the  Mrth  of  the  fifth  child,  I 
again  treated  him  for  a  gummous  tumor  of  the  palate  of  a 
very  threatening  aspect. 

Here,  then,  is  a  man  who  has  begotten  six  healthy 
children,  despite  a  syphilis,  active,  persistent,  and  still  re- 
vealing itself  by  intense  symptoms  after  the  date  of  con- 
ception of  these  several  children. 

Again,  one  of  my  old  patients  married,  without  con- 
sulting me,  despite  a  syphilis  very  insufficiently  treated. 
He  has  two .  children,  that  I  have  not  lost  sight  of  since 
their  birth,  and  who  have  always  remained  free  from  the 
slightest  specific  manifestation.  (The  elder  is  at  present 
fourteen  years  of  age,  the  younger  twelve.)  ISTow,  this 
man  recently  died  from  cerebral  syphilis,  not  only  diag- 
nosticated such  from  the  clinical  symptoms,  but  verified 
by  microscoj)ic  examination. 

Are  not  these  two  cases,  and  many  others  which  I 
could  add,  absolutely  convincing  ?  * 

But,  still,  this  is  not  all.  I  have  known  syphilitic  pa- 
tients to  procreate  healthy  children,  free  from  the  least 
suspicious  symptom,  when  they  were  in  the  full  second- 
ary period,  when  they  were  affected,  even  at  the  moment 
of  conception,  with  various  syphilitic  accidents — when,  in 

*  In  statistics  which  will  be  produced  farther  on  (V.  Notes  and  Illustrative 
Cases),  the  reader  will  find  not  less  than  thirty-five  cases  of  this  kind,  all  relating 
to  syphilitic  subjects  who  have  engendered  healthy  children,  and  who,  after  the 
birth  of  these  children,  have  been  again  attacked  with  various  specific  accidents. 


PATERNAL  HEREDITY.  37 

a  word,  they  had  not  passed  that  formidable  period  where 
the  diathesis  has,  so  to  speak,  its  acute  crisis,  and  seems 
really  to  be  the  most  pernicious,  so  far  as  the  dangers  of 
hereditary  transmission  are  concerned."^" 

I  have  among  my  notes  cases  of  this  kind,  but  none 
of  them,  certainly,  so  convincing  as  a  case  of  the  same 
character  which  has  been  obligingly  communicated  to  me 
by  our  very  distinguished  colleague,  M.  Maurice  Ray- 
naud, and  which,  occurring  under  conditions  altogether 
special,  offering  a  chronology  of  quasi-mathematical  pre- 
cision, merits  in  every  respect  a  place  here :  A  married 
man  contracts  syphilis  in  an  extra-conjugal  adventure. 
During  several  months  he  invents  ingenious  pretexts  to 
avoid  connection  with  his  wife  ;  but,  finally,  one  day  he 
forgets  himself.  The  next  day  he  rushes  frightened  to 
M,  Raynaud,  who  discovers  mucous  patches  in  his  mouth. 
Mne  months  later,  to  a  day,  and  without  any  other  sub- 
sequent intercourse,  the  young  wife  was  confined,  and 
confined  of  a  healthy  child,  which,  though  now  ten  years 
old,  has  never  exhibited  the  slightest  evidence  of  syphi- 
litic infection. 

Thus,  here  is  a  syphilitic  man  who,  tlie  mry  day  when 
Tie  procreates  a  cliild,  presents  accidents  of  the  secondary 
stage,  and  whose  child,  nevertheless,  is  born  exempt  from 
syphilis  !     What  more  convincing  ! 

You  see,  then,  gentlemen,  I  dissemble  nothing.  Very 
far  from  it.  On  the  contrary,  I  insist  with  all  my  strength 
upon  the  importance  of  these  facts,  so  curious;  of  the 
non-hereditary  transmission  of  syphilis  through  paternal 
influence ;  for  these  facts  constitute,  in  my  view,  one  of 
the  most  interesting  acquisitions  of  contemporary  science  ; 

*  Many  cases  of  this  kind  are  found  embodied  in  the  interesting  work  of  M.. 
Notta,  to  which  we  have  previously  made  allusion. — Arch.  gen.  de  med.,  1860,  t.  J. 


38-  SYPHILIS  AND  MARRIAGE. 

and  I  need  say  nothing  of  the  importance  they  acquire  in 
connection  -with  the  subject  which  we  are  now  consider- 
ing. The  conclusion  from  the  foregoing  is,  that  syphilitic 
heredity  proceeding  from  the  father  (and  from  the  father 
alone,  the  mother  remaining  healthy)  is  much  less  active, 
much  more  restricted,  than  had  heretofore  been  suj)posed. 
Under  given  conditions,  on  tlie  one  hand,  a  sypMlitic 
Jiushand,  and  on  the  other  a  healthy  wife,  the  chances 
altogether  are  that  the  child  issuing  from  this  couple  loill 
he  horn  exempt  from  syphilis.  This,  contrary  to  the  old 
beliefs,  contemporary  researches  have  clearly  and  positive- 
ly established  ;  and  this  result,  certainly,  in  what  con- 
cerns us,  can  not  fail  to  be  most  consoling. 

II.  But,  this  fact  recognized,  this  concession.made  to  the 
partisans  of  the  doctrine  which  I  oppose,  I  at  once  resume 
my  position  on  the  strength  of  observation,  on  the  strength 
of  clinical  facts,  and  I  say  to  my  opponents  : 

ISTo,  it  is  not  true,  very  unfortunately,  in  the  case  of 
syphilis,  that  the  paternal  influence  is  so  immaterial  as  has 
been  pretended ;  still  less  is  it  true  that  it  is  null,  that 
it  exercises  no  influence  whatever  upon  the  foetus.  To 
enunciate  such  propositions,  you  must  look  only  upon  one 
side  of  the  question,  you  must  regard  only  one  element 
of  the  problem  ;  for  there  is  a  vast  difference  between  the 
conclusions  at  vv^hich  you  have  arrived  and  those  which 
are  derived  from  an  integral  observation  of  the  clinical 
facts.     Judge  of  this,  however,  by  what  follows  : 

In  the  first  place,  if  paternal  heredity,  as  we  have 
termed  it,  exercises  its  influence  in  a  rare,  exceptional 
manner,  still  it  exercises  it  sometimes.  AVe  have  seen  that 
children  are  bom  syphilitic  through  the  agency  of  their  fa- 
ther, their  mother  remaining  exempt  from  all  contamina- 
tion.   Numbers  of  cases  of  this  kind  have  been  related  by 


PATERNAL  HEREDITY.  39 

different  authors,  notably  Iby  MM.  Ricord,  Trousseau,  Di- 
day,  Depaul,  Cazenave,  Bazin,  Hardy,  Barensprung,  Hut- 
chinson,  Bassereau,  Beyran,  Martinez  y  Sancliez,  Liegeois, 
De  Meric,  Martin,  Parrot,  Lancereaux,  Kassowitz,  Char- 
pentier,  Pozzi,  Keyfel,  Carl  Ruge,  and  others.*  I  my- 
self have  likewise  observed  some  cases,  although  rela- 
tively few,  I  confess,  t  I  recently  met  one  of  my  confreres 
who,  while  doing  me  the  honor  to  consult  me  for  an  old 
syphilis,  said  to  me  that  "  he  had  had  five  syphilitic  chil- 
dren, although  his  vdfe  (examined  by  him  with  the  most 
vigilant  care),  submitted  to  the  most  assiduous  observa- 
tion, had  never  presented  the  least  diathetic  symptom." 
That,  among  the  facts  cited  in  support  of  this  argu- 


*  See  an  interesting  work  of  Dr.  Leon  Richard  {J&tude  sur  VMredite  dans  la  syphi- 
lis ;  de  Vinfluence  dupere. — TJieses  de  Paris,  18'JO),  which  reproduces  en  resume  a 
certain  number  of  cases  under  consideration  here. 

See  also :  Piquand,  Influence  de  la  syphilis  des  generateurs  sur  la  grossesse. — 
TJieses  de  Paris,  1868. 

Bricard  (Ph.),  De  la  transmission  de  la  syphilis  du  pere  d  V enfant  avec  immunite 
de  la  mere. — Theses  de  Paris,  18 '71. 

Kassowitz,  Die  Vererhung  der  Syphilis.     Vienna,  1876. 

Carl  Ruge,  Ueber  die  Fodus  Sanguinolentus. — Zeif  fur  Gehurtsh.  und  Gynakologie, 
B.  I. — Analysis  in  Pevue  des  sciences  medicales,  t.  xii,  p.  203, 

Professor  Parrot  has  recently  narrated  to  me  a  case  of  this  kind  observed  by 
him  under  special  conditions  which  leave  no  possibility  of  error :  "  A  young  man, 
married,  with  a  syphilis  in  full  activity.  He  had  two  children,  who  both  presented 
undoubted  symptoms  of  hereditary  syphilis.  Now,  their  mother,  closely  watched 
over,  minutely  examined  from  time  to  time  since  her  marriage,  has  never  presented, 
and  still  does  not  present,  any  suspicious  symptom.  Without  doubt,  she  remains 
entirely  exempt." 

Mr.  Hutchinson  is  still  much  more  pronounced  in  favor  of  paternal  heredity : 
"  I  am  firmly  of  opinion  that,  in  a  large  majority  of  instances  in  English  practice, 
inheritance  of  syphilis  is  from  the  father,  the  mother  having  never  suffered  before 
conception"  ("Medical  Times  and  Gazette,"  December,  18*76;  v.  likewise,  "A  Clin- 
ical Memoir  on  Certain  Diseases  of  the  Eye  and  Ear,  consequent  on  Inherited 
Syphilis,"  p.  209,  London,  1863  ;  "  On  the  Transmission  of  Syphilis  from  Parent 
to  Offspring,"  "  British  and  Foreign  Med.-Chir.  Review,"  1877,  vol.  Ix,  p.  455). 

f  I  find  in  my  notes  only  eight  cases  of  this  kind.  Even  some  of  these  are 
wanting,  I  admit,  in  the  guarantees  of  authenticity  which  would  be  required  in  a 
matter  so  delicate  and  so  disputed. 


40  SYPHILIS  AND  MARRIAGE. 

ment,  and  reproduced  in  various  monographs  and  reports, 
there  are  a  certain  number  to  be  excluded,  to  be  chal- 
lenged on  account  of  insufficient  guarantees,  I  do  not 
deny  ;  rather,  I  will  affirm  it,  if  need  be.  But  will  it  be 
possible  to  challenge  all,  at  once  and  in  a  lump  ?  Is  it  to 
be  believed  that  all  the  authors,  who  have  seen,  jDublished, 
and  commented  upon  such  facts,  have  together  fallen  into 
the  same  en-or,  in  aU  failing  to  recognize  syphilis  in  the 
mothers  of  the  children  that  they  had  under  observation  ? 
ISTo,  indeed.  That  is  not  admissible.  However  zealous 
a  partisan  one  may  be  of  the  new  doctrine,  one  is  not  au- 
thorized, it  seems  to  me,  to  throw  overboard  the  whole 
bundle  of  former  observations  which  contravene  this  doc- 
trine, except  after  a  long,  very  long  and  ultra-sufficient  ex- 
perience. ISTow,  an  experience  of  this  kind  is  still  wanting 
to  us ;  so  that,  actually,  in  the  present  state  of  our  knowl- 
edge, it  is  absolutely  necessary  for  us  to  take  cognizance 
of  the  facts  brought  forward  in  favor  of  paternal  heredity, 
and  to  admit  this :  That,  Tioioever  rare,  Tioioemr  excep- 
tional the  hereditary  transmission  of  syphilis  from  the 
father  to  the  foetus  may  appear  to  lye,  it  may,  nevertJieless, 
exert  itself  in  this  way  in  a  certain  nuonher  of  cases. 
Consequently,  in  that  which  concerns  us,  this  is  the  first 
danger  which  it  is  necessary  to  calculate,  in  order  to  render 
a  verdict  upon  the  fitness  for  marriage  of  a  patient  tainted 
with  syphilis. 

III.  But  even  this,  as  you  will  see,  and  as  I  am  anxious 
to  convince  you,  is  only  the  lesser  side  of  the  question. 
For,  in  a  manner  much  more  frequent  and  much  less  con- 
testable, the  syphilis  of  the  father  creates  for  the  child 
other  dangers  of  a  graver  character.  What,  then,  are  these 
dangers  ?    To  summarize,  they  consist  in  this  : 

1.  Inaptitude  for  life,  revealing  itself  by  the  early 


PATERNAL  HEREDITY.  41 

death  of  the  foetus,  either  in  utero  or  very  shortly  after 
birth. 

2.  Constitutional  vices,  morbid  aptitudes,  defects,  in- 
herent infirmities,  congenital  malformations,  arrests  of 
development,  etc.,  which  I,  like  many  physicians,  look 
upon  as  constituting  the  modified,  transformed  expres- 
sions of  specific  heredity. 

We  have  here,  certainly,  relative  to  the  question  which 
we  are  examining,  a  whole  series  of  considerations  well 
worthy  of  our  careful  attention.  We  are  here  in  the  very 
heart  of  our  subject.  Let  us  insist,  then,  upon  the  sev- 
eral points  which  I  have  Just  raised. 

I  have  said,  in  the  first  place,  that  one  of  the  conse- 
quences of  paternal  syphilis  for  the  child  may  be  inapti- 
tude for  life,  inaptitude  revealing  itself  by  death  in  utero. 
In  other  words,  a  child  horn  of  a  syphilitic  father  and  of 
a  healthy  motlier  is  liable,  hy  the  fact  of  the  paternal 
syphilis,  to  die  before  coming  into  the  world.  That  is  a 
principal  point  upon  which  my  conviction  is  now  well 
established.  Formerly,  I  was  struck  with  the  frequency 
of  abortions  in  families  where  the  husband  was  infected 
with  syphUis,  while  the  wife  remained  perfectly  healthy. 
Afterward,  I  determined  to  confirm  this  general  impres- 
sion by  instituting  a  precise  inquiry  into  the  matter. 
With  this  view,  I  applied  myself  to  note  the  results  of 
the  union  of  a  syphilitic  man  with  a  healthy  woman  in  a 
very  exact  manner  in  all  the  cases  which  came  under  my 
observation.  IN'ow,  after  several  years  of  investigation 
in  this  direction,  an  abstract  of  my  observations  furnishes 
me  with  no  fewer  than  fifty  abortions  occurring  under  the 
above-mentioned  conditions,  and  produced  without  other 
possible  cause  to  be  alleged  than  the  paternal  diathesis. 
And  be  pleased  to  note  (it  is  essential  to  specify  this)  that 


42  SYPHILIS  AND  MARRIAGE. 

the  dements  of  these  statistics  have  been  collected  in 
private  practice,  in  a  hourgeoise  practice  ;  that  is  to  say, 
in  a  social  medium  where  the  anti-hygienic  conditions  of 
misery,  of  forced  work,  of  fatigue,  of  insufficient  ali- 
mentation, of  excess,  of  debauch,  etc.,  have  not  played 
any  role  as  predisposing  causes  of  the  abortion.  ]S"ote 
that  they  have  been  collected  (thus  the  analysis  of 
my  observations  demonstrates)  among  young  women  in 
very  good  health  for  the  most  part,  recently  married,  pre- 
senting no  uterine  lesion,  etc.  So  that,  in  all  these  cases 
(excepting  two  or  three  at  most),  no  other  cause,  either 
constitutional  or  accidental,  could  be  alleged  as  sufficient 
reason  for  the  abortion.  The  abortion  remains  inexpli- 
cable upon  the  assumption  of  the  influences,  predisposing 
or  determinant,  to  which  it  is  usually  attributable,  while, 
on  the  contrary,  a  common  etiological  element  reunites 
all  these  cases  and  serves  as  a  common  explanation  for 
them,  viz.,  tJie  sypMlis  of  tlie  Tiusband.  Is  not  this  well 
adapted  to  enforce  conviction  % 

Add,  moreover,  that  this  fatal  influence  of  paternal 
heredity  does  not  manifest  itself  always  by  a  single  abor- 
tion. Often  it  is  prolonged  ;  it  is  continued  in  the  course 
of  several  pregnancies  more  or  less  close  together.  So 
that  two,  three,  four  miscarriages  sometimes  succeed,  one 
after  another,  without  other  exj)lanation  than  the  syphilis 
of  the  husband.  The  cases  of  this  kind  are  not  rare,  I 
repeat.  I  can  cite  more  than  twenty  examples  in  my 
practice  alone.  "^ 

Such  facts,  certainly,  are  significant  of  themselves,  but 
they  assume  a  value  much  more  exact  still,  when  a 
counter-proof  comes  to  be  added  as  follows  :  Apprised  by 

*  J.  Hutchinson,  "  On  the  Transmission  of  Syphilis  from  Parent  to  Offspring." 
—"Brit,  and  For.  Med.-Chirurg.  Review,"  IS?*?,  vol.  Lx. 


PATEBNAL  HEREDITY.  43 

his  physician  of  the  probable  cause  of  these  successive 
abortions,  the  husband  submits  himself  to  a  prolonged 
specific  treatment.  There  occurs  afterward  a  new  preg- 
nancy, which  results  in  an  infant  at  full  term.  Other 
pregnancies  succeed,  and  these  are  not  less  fortunate, 
Now,  then,  the  evidence  is  conclusive  ;  how  can  we  deny, 
under  such  circumstances,  the  corrective  influence  of  the 
treatment  upon  the  syphilitic  diathesis,  and  how  can  we 
fail  to  recognize  the  influence  of  this  diathesis  upon  former 
pregnancies  ?  Successive  abortions  he/ore  treatment ;  for- 
tunate pregnancies  after  treatment;  what  could  be  more 
demonstrative  I  Now,  cases  of  this  kind  exist  in  medical 
literature.  They  exist  especially  in  a  very  much  larger 
number  in  the  memory  of  practitioners,  as  I  have  con- 
vinced myself  by  many  conversations  with  my  confreres. 
I  myself  have  observed  several,  such  as  the  following,  for 
example,  which  vividly  impressed  me  at  the  beginning  of 
my  career,  and  which  I  can  not  resist  the  desire  to  relate 
to  you  briefly :  Fifteen  years  ago  I  encountered,  by 
chance,  an  old  college  comrade  whom  I  had  long  lost  from 
view.  We  talked  together,  and  he  related  his  troubles  to 
me.  "  You  see  me  disappointed,"  he  said  ;  "  my  wife  has 
just  had  her  fourth  miscarriage  in  an  early  period  of  preg- 
nancy ;  and,  what  is  worse,  all  these  miscarriages  have 
taken  place  without  the  least  cause — without  a  fall,  with- 
out imprudence  on  her  part.  My  wife  is  large,  strong, 
well  developed,  perfectly  healthy ;  and,  nevertheless,  I 
foresee,  to  my  great  grief,  that  she  will  never  bear  me 
children."  The  recollection  of  a  certain  circumstance 
then  crossed  my  mind,  and  I  replied:  "But,  perhaps, 
your  wife  is  not  so  responsible  as  yourself  for  these  suc- 
cessive miscarriages.  I  knew  you  many  years  ago,  in  the 
Quartier    Latin,   with  a  fine  pox,   which  you  did   not 


44  SYPHILIS  AND  MARRIAGE. 

appear  to  me  to  attend  to  in  a  very  exemplary  manner. 
In  your  place,  I  would  commence  a  course  of  treatment ; 
I  would  again  take  mercury  and  iodide." 

Altliough  this  interview  took  place  in  tlie  street,  my 
advice  was  followed,  and  specific  treatment  was  pur- 
sued actively.  Fifteen  months  later  my  friend's  wife  was 
delivered,  at  full  term,  of  a  living  cliild,  wMcli  is  now 
twelve  years  old.  And  since  that  she  has  had  three  other 
pregnancies  equally  favora]:)le.'^"  The  undeniable  inference 
from  all  this  is,  that  numbers  of  abortions  happening 
without  cause  in  healthy  women  admit  of  no  other  ex- 
planation than  that  of  the  husband's  syphilis. 

The  sypMUtic  influence  of  tlie  father  Mils  the  foetus  in 
utero.  Here  is  a  fact  which,  supported  by  observations 
as  authentic  as  they  are  numerous,  merits  a  place  in  sci- 
ence ;  and  I  am  astonished  that  it  has  not  been  more  re- 
marked before.  In  the  second  place,  this  same  iiiaptitude 
for  life  of  the  infant  procreated  by  a  syphilitic  father 
reveals  itself  by  death  immediately  upon.,  or  soon  after, 
delimry. 

In  the  statistics  from  which  I  have  borrowed  the  fore- 
going facts,  I  find  no  fewer  than  thirty-six  other  cases  of 
pregnancy  (always  the  issue  of  a  syphiUtic  father  and  a 
healthy  woman)  which  have  resulted  at  term  in  infants 
torn  dead  or  dying,  or  sickly,  stunted,  emaciated,  senile 
children,  doomed  to  an  early  death.  Sometimes,  again 
(a  detail  curious  and  essential  to  know  in  practice),  infants 
procreated  under  these  circumstances  come  into  the  world 
in  a  passable  or  average  condition ;  then,  after  a  few  days, 
after  a  few  weeks  at  most,  they  are  suddenly  extin- 
guished ;  they  die  without  disease,  without  apparent 
cause,   from   one    day  to  another.      Of   what    do    they 

*  M,  Depaul  has  related  several  facts  of  this  kind  in  his  able  clinical  lectures. 


PATERNAL  EEEEDITY.  45 

die  ?  I  am  unable  to  say ;  for,  in  those  cases  in  wl^ich  I 
have  had  an  opportunity  to  make  an  autopsy,  I  have  dis- 
covered nothing  which  could  explain  this  kind  of  death. 
They  always  succumb  very  rapidly,  almost  instantaneous- 
ly, and  this  without  an  attack,  without  very  pronounced 
morbid  symptoms,  to  the  very  great  surprise  of  their 
parents  and  of  the  physician.  And,  without  doubt,  they 
succumb  only  on  account  of  a  congenital  vice,  of  a  native 
debility,  of  an  ^'- inlierent  inaptitude  for  life,''''  rather 
than  from  a  superadded,  contingent,  incidental  morbid 
cause. 

This  is  not  all  yet.  The  more  I  advance  in  practice, 
the  more  I  perceive  myself  pervaded  by  the  conviction 
that  the  infl.uen9e  of  a  syphilitic  father  upon  his  child 
still  reveals  itself  after  birth  in  various  ways  :  by  a  gen- 
eral organic  debility  ;  by  a  constitution  enfeebled,  impov- 
erished, "  delicate,"  as  the  common  people  say,  below  the 
normal  average ;  by  a  slight  power  of  resistance  to  mor- 
bific causes,  which  impresses  upon  incidental  maladies  a 
character  of  pernicious  malignity  ;  by  a  tendency  to 
nervous  accidents,  notably  to  convulsions  ;  by  a  tendency 
to  lymphatic  and  scrofulous  affections,  etc. 

But  let  me,  for  the  present,  reserve  this  class  of  con- 
siderations until  we  come  to  discuss  the  question  of  mixed 
heredity — I  mean  paternal  heredity  and  maternal  heredity 
combined. 

To  recapitulate,  then,  the  hereditary  influence  of  pater- 
nal syphilis  is  far  from  being  so  innocuous,  so  slight, 
so  "null,"  as  it  has  pleased  certain  authors  to  assert. 
They  have  said  that  the  procreation  of  an  infant  by  a 
syphilitic  father  signified  nothing,  since  the  child  had 
nothing  to  fear  from  paternal  inheritance."^    This  is  a 

*  Criticising  this  doctrine,  M.  Voillemier  has  wittily  said  :  "  If  one  accepts  the 


40  SYPHILIS  AKD  MARRIAGE. 

great  and  dangerous  error,  whicli  good  sense  reproves  a 
priori,  and  which  clinical  observation  refutes. 

In  reality,  paternal  influence,  while  not  exercising  it- 
self (as  we  have  previously  shown)  except  in  a  limited 
number  of  cases,  is  none  the  less  liable  to  exercise  itself 
sometimes  in  a  manner  very  positive,  very  manifest,  and 
then  it  reveals  itself  according  to  three  modes  : 

Either  (this  is  the  exceptional  case)  by  the  transmission 
of  syphilis  to  the  foetus  ;  or  (this  is  much  more  common) 
by  the  death  of  the  child  ;  or,  finally,  by  inherent  degen- 
eration of  the  germ,  which  reveals  itself  subsequently 
under  very  diversified  morbid  forms. 

ideas  of  M.  Cullerier,  the  father  would  be  only  the  accidental  occasion  of  a  child. 
One  would  be,  in  reality,  the  child  of  his  mother  only." — Gazette  des  Hopitaux,  1854, 
p.  303. 


CHAPTER  V. 

MIXED    HEREDITY. 

Let  us  not  lose  sight  of  tliis  other  cardinal  point : 
A  syphilitic  father  is  dangerous  to  his  children  not  only  in 
his  character  of  progenitor  ;  he  is,  or  may  become,  danger- 
ous to  them  in  his  character  as  the  husband  of  their 
mother,  if  I  may  so  express  it.  In  other  words,  he  may 
endanger  them  through  tJie  syphilis  which  he  runs  the 
risJc  of  comTnunicating  to  Ms  wife.  And  then,  the  father 
and  the  mother  both  becoming  syphilitic,  what  must  be 
the  fate  of  the  children  issuing  from  this  infected  couple  ? 

Ah !  here,  gentlemen,  is  presented  a  page  of  pathology 
distressing  to  write  ;  here  commences  for  these  families  a 
situation  truly  heart-rending,  which  it  is  necessary  to  have 
observed  in  all  its  details  and  in  its  diverse  forms  in 
order  to  comprehend  its  miseries. 

This  situation,  which  I  am  anxious  to  depict  faithfully 
to  you  in  the  interest  of  the  grave  subject  now  before  us, 
is  here  copied  from  nature  in  its  sad  reality : 

Two  young  persons  were  married  a  short  time  ago. 
The  wife  has  become  enceinte,  and  yearns  after  her  title 
of  mother.  The  two  families,  full  of  the  sweet  hope  which 
preludes  the  coming  of  the  new-born,  impatiently  await 
the  result  of  this  pregnancy.  Now,  what  will  be  the  re- 
sult ?    What  will  happen  to  the  infant  procreated  under 


48  SYPHILIS  AND  MARRIAGE. 

the  conditions  which  we  are  now  supposing — that  is  to 
say,  issuing  fi-om  a  father  and  mother  both  syphilitic? 
As  physicians,  we  can  predict  what  will  haj^pen  to  it,  for, 
save  rare  exceptions,  its  future  is  comprised  within  the 
three  folloAving  alternatives :  1,  either  this  infant  will  die 
before  hirth ;  2,  or  it  will  come  into  the  world  with  syph- 
ilis., and  ^^ith  all  the  possible  and  serious  consequences  of 
infantile  syphilis,  which,  in  most  cases,  is  almost  equiv- 
alent to  a  sentence  of  death  ;  3,  or,  finally,  it  will  come 
into  the  world  mthout  sj^philis,  but  with  a  health  com- 
promised,  with  an  innate  dehility,  and  a  constitution 
impoverished,  which  -udll  expose  it  to  an  early  death,  with 
menacing  morbid  aptitudes,  and  with  a  tendency  to  cer- 
tain organic  vices. 

And  this  is  not  all,  for  there  may  succeed  a  second,  a 
third,  a  fourth  pregnancy.  It  may  be  that  this  identical 
fate  awaits  the  second,  the  third,  the  fourth  infant ;  and 
so  on  until  the  diathesis  has  been  exhausted  by  the  effect 
of  time  or  by  the  intervention  of  an  energetic  treatment. 

What  a  situation !  What  affliction  for  a  young  couple  ! 
"\Yhat  grief  for  their  two  families  !  And,  in  another  point 
of  view,  what  a  social  calamity  ! 

That,  gentlemen,  is  what  the  pox  does,  or  can  do,  when 
the  paternal  influence  and  the  maternal  influence  are  asso- 
ciated ;  when  both  conspire  together  against  the  product 
of  conception. 

And  these  sad  results  I  do  not  give  you  as  only  con- 
tingent, as  simply  possible  ;  I  give  them  to  you,  if  not  as 
constant  (for,  in  fact,  nothing  is  constant  in  heredity),  at 
least  as  very  frequent,  very  common,  absolutely  habitual. 

But  (for  the  matter  is  worth  the  trouble)  let  us  insist 
upon  and  legitimize  the  summarized  facts  which  precede  : 

1st.  I  said  to  you  a  moment  ago  that  the  infant  bom 


MIXED  HEREDITY.  49 

of  a  syphilitic  father  and  mother  is  almost  necessarily 
doomed  to  one  or  another  of  the  three  alternatives  which 
I  have  jnst  specified,  and  which  it  now  remains  for  ns  to 
study  in  detail. 

The  first  is  deatli  in  utero  ;  whence  abortion,  or  delivery 
before  term. 

Upon  this  first  point  there  is  no  possible  contradiction. 
Here  medical  science  is  fixed,  and  securely  fixed,  by  the 
unanimity  of  its  practitioners. 

Open  your  books  ;  run  over  the  observations  contained 
in  the  classic  treatises,  in  the  special  works,  and  you  will 
find  not  only  hundreds  but  thousands  of  cases,  which,  in 
the  point  of  view  from  which  we  are  speaking,  all  testify 
to  the  same  effect,  and  seem  copied  one  from  another. 
Everywhere  and  always,  it  is  identically  the  same  observa- 
tion, stereotyped,  so  to  speak,  reproducing  itself  in  the 
same  terms,  and  summarizing  itself  thus  :  "A  man  in  a 
syphilitic  condition  marries.  In  one  way  or  another  he 
infects  his  wife.  She  becomes  enceinte.,  and  aborts  in  a 
few  months,  or  is  delivered  before  term  of  a  dead  infant." 

The  intra-uterine  death  of  the  foetus,  the  offspring  of 
syphilitic  parents,  is  certainly  the  most  habitual  expres- 
\sion  of  the  hereditary  influence  of  the  diathesis.  In  truth, 
this  fact  is  so  common,  so  trite,  so  accurately  verified  by 
numerous  observations,  that  I  restrict  myself  here  to  enun- 
ciating it  only.  It  would  be  but  an  abuse  of  your  time  for 
me  to  stop  here  in  order  to  cite  particular  cases. 

The  pernicious  influence  of  mixed  syphilitic  heredity, 
that  is,  proceeding  from  both  husband  and  wife,  does  not 
always  end  here  in  such  a  situation.  Yery  often,  still, 
this  is  continued,  is  prolonged  in  a  series  of  successive 
abortions. 

We  have  seen  many  and  many  cases  of  unfortunate 


50  SYPHILIS  AND  MARRIAGE. 

syphilitic  wives,  who  have  become  enceinte  from  contact 
with  syphilitic  men,  terminate  thus  twice,  three  times, 
four  times,  five  times,  six  times,  and  even  seven  times  in 
succession,  either  from  abortion  or  from  exi)ulsion  before 
term  of  infants  dead  or  moribund.  This  very  day  I  can 
show  you  in  our  wards  a  case  of  this  kind.  The  patient 
lying  in  bed  No.  35,  St.  Thomas's  Ward,  received  syphilis 
from  her  husband  several  years  ago.  Since  then,  this 
woman  has  become  enceinte  six  times,  and  she  has  aborted 
six  times  in  the  third,  fourth,  or  fifth  month  of  her  preg- 
nancies. Likewise,  one  of  my  patients,  young  and  well 
developed,  contracted  syphilis  from  her  husband  soon 
after  marriage.  She  became  enceinte  four  times  in  three 
years,  and  aborted/owr  times. 

Cases  of  this  kind  have  been  cited  by  a  number  of  ob- 
servers. But  I  know  nothing  of  this  descriiDtion  compar- 
able to  the  history  of  a  patient  that  I  treated  for  a  long 
time  at  the  Lourcine — a  history  which  you  wiU  permit  me 
to  reproduce  here  briefly. 

This  woman,  large,  vigorous,  perfectly  healthy,  mar- 
ried at  nineteen  years  of  age.  She  commenced  by  having 
three  "superb"  children,  two  of  whom  are  still  living, 
and  are,  according  to  her  statement,  in  excellent  health. 
The  third  appears  to  have  succumbed  to  some  incidental 
disease  of  an  acute  form.  After  her  third  confinement, 
this  woman  received  syphilis  from  her  husband,  which  he 
had  contracted  a  short  time  previously  in  an  amorous  es- 
capade. Since  then,  she  has  been  enceinte  seven  times. 
Now,  what  has  been  the  termination  of  these  numerous 
pregnancies  subsequent  to  the  contagion?  The  result  is 
curious  and  dismal,  in  truth  : 

First  pregnancy  (after  the  syphilis) :  Abortion  in  the 
fifth  month. 


MIXED  HEREDITY.  51 

Second  pregnancy :  Premature  accoucliement  at  seven 
months  and  a  half.  Infant  sickly,  emaciated,  dying  the 
fifteenth  day. 

Third  pregnancy  :  Accouchement  almost  at  term.  In- 
fant born  dead. 

Fourth  pregnancy :  Accouchement  premature.  Infant 
still-born. 

Fifth  pregnancy  :  Accouchement  premature.  Infant 
stiU-born. 

Sixth  pregnancy :  Abortion  at  three  and  a  half  months. 

Seventh  pregnancy :  Abortion  at  six  weeks. 

Resume  :  Ten  pregnancies,  of  v^hich  the  three  previous 
to  the  syphilis  resulted  in  three  children  at  full  term  and 
perfectly  healthy,  and  the  seven  subsequent  to  the  syphilis 
resulted  in  four  premature  deliveries  and  three  abortions  ! 
What  fact  more  instructive  %  and  what  could  you  de- 
mand more  probatory  in  support  of  the  thesis  which  we 
are  developing  ?  * 

2d.  Second  alternative:  The  infant  issuing  from  a 
syphilitic  couple  may  be  born  alive,  but  it  is  horn  with 
sypMlis,  and  bears  all  the  consequences,  so  grave  and  so 
formidable,  of  hereditary  syphilis. 

Here,  again,  long  developments  are  not  needed  to  es- 
tablish two  facts  which  are  patent,  which  spring,  with  an 
evidence  unfortunately  too  manifest,  from  common,  al- 
most daily  experience,  viz. : 

1.  That  the  offspring  of  syphilitic  parents  are  most  ha- 

*  See  Illustrative  Cases,  Note  11,  the  relation  in  extenso  of  this  curious  case.  I 
owe  the  communication  of  another  analogous  case  to  Dr.  Le  Pileur,  physician 
to  Saint  Lazare.  This  case  is  briefly  as  follows:  Wife,  syphilitic,  becomes  en- 
ceinte eleven  times.  Of  these  eleven  pregnancies,  five  are  terminated  by  abortion 
or  by  the  expulsion  of  still-born  infants  at  various  epochs  of  gestation.  Six  others 
resulted  in  living  children,  of  whom  five  died  from  convulsions,  viz. :  four  the  first 
or  second  day,  and  the-fifth  at  six  weeks.  One  child  alone  has  survived.  Eleven 
pregnancies,  ending  in  a  sole  case  of  survival ! 


52  SYPHILIS  AFD  MAREIAOE. 

bitually  born  syphilitic,  especially  in  the  course  of  tlie  ear- 
lier pregnancies  wliich  succeed  the  infection  of  the  parents, 
that  is  to  say,  when  time  and  treatment,  those  two  great 
correctives  of  the  pox,  have  not  yet  exercised  upon  the 
diathesis  of  the  generating  couple  their  attenuating  and 
depurative  influence.  This  first  fact  is  neither  contestable 
nor  contested.   It  is  useless,  then,  to  insist  further  upon  it. 

2.  That  children  who  are  born  with  hereditary  sjrphilis 
are  exposed,  by  virtue  of  this  syi)hilis,  to  multiple  and 
most  serious  dangers.  By  dint  of  care,  we  succeed,  indeed, 
in  curing  a  certain  number  of  them.  But,  whatever  we 
may  do,  despite  all  treatment,  a  very  large  number  suc- 
cumb. I  do  not  hesitate  to  confess  that  my  personal  sta- 
tistics of  the  syphilitic  new-born,  even  when  treated,  are 
truly  deplorable  as  a  mortuary  table.  Nothing  is  so  mur- 
derous as  hereditary  infantile  syphilis.  This  is  a  second 
fact  which  again  it  will  suffice  simply  to  enunciate,  so  com- 
monly is  it  observed. 

3d.  Third  and  last  alternative :  It  is  possible  that 
a  child  born  of  syphilitic  parents  may  escape  death  in 
utero,  or  even  the  syphilis.  But  it  is  not  yet  free  from 
danger  for  all  that,  since  the  syphilitic  influence  may  still 
exert  itself  ui3on  it  in  other  forms,  which  it  now  remains 
for  me  briefly  to  point  out. 

I  must  tell  you  that  we  have  here  to  deal  with  one  of 
the  most  difficult  and  most  delicate  points  iu  pathology. 
Indeed,  just  as  hereditary  influences  are  direct  and  unmis- 
takable when  transmitted  from  one  generation  to  another 
by  the  reproduction  of  the  same  malady,  so  they  become 
doubtful  and  questionable  in  opposite  conditions,  that  is 
to  say,  when  they  reveal  themselves  in  the  offs]oring  by 
symptoms  different  from  those  manifested  in  the  parents. 
And,  nevertheless,  this  lieredity  with  dissimilar  morhid 


MIXED  HEREDITY,  53 

forms,  if  I  may  thus  express  it,  is  no  less  authentic  than 
is  the  other  heredity,  with  identical  morbid  forms,  only  it 
oftener  escapes  attention,  as  it  does  scientific  demonstra- 
tion. Such  is  the  case  here.  The  entire  profession  grants 
the  syphilitic  heredity  which  reveals  itself  from  one  gen- 
eration to  the  following  generation  by  symptoms  of  a 
syphilitic  order,  while  they  have  long  discussed,  and  will 
long  continue  to  discuss,  the  question  whether  the  syph- 
ilitic influence  of  parents  can  exert  itself  upon  their 
descendants  by  manifestations  or  morbid  tendencies 
not  directly  entering  into  the  list  of  symptoms  of  this 
diathesis. 

As  for  me,  my  position  is  taken  upon  this  question, 
which  has  loug  engaged  my  attention,  and  which  I  have 
studied,  I  believe  I  can  say,  with  minute  attention.  After 
having  doubted,  I  doubt  no  longer,  and  my  present  con- 
viction is  that  the  syphilitic  influence  of  parents  does  not 
reveal  itself  in  their  children  by  symptoms  of  a  syphilitic 
order  only,  but  also  by  morbid  conditions,  by  morbid  dis- 
positions, nowise  syphilitic  in  themselves,  which  have 
nothing  to  do  with  the  classic  symptomatology  of  the  pox, 
which  are  even  as  different  from  it  as  possible,  but  which, 
nevertheless,  do  constitute  modified  expressions  of  the  dia- 
thetic state  of  the  ancestors,  do  constitute,  if  I  may  so  ex- 
press it,  a  sort  of  indirect  descent  of  the  pox. 

And,  moreover,  what  is  there  singular,  what  abnormal, 
what  inexplicable  in  this  hereditary  modality?  Does 
syphilis  have  for  symptoms  in  the  subject  which  it  affects 
only  manifestations  of  a  specific  order?  Is  everything 
that  it  produces,  everything  that  it  determines  in  the  way 
of  morbid  troubles,  always  and  invariably  of  a  specific 
order  ?  Parallel  with  its  peculiar  lesions,  has  it  not  also 
a  train  of  general  symptoms  ?    At  the  same  time  that  it 


64  SYPHILIS  AND  MARRIAGE. 

attests  itself  in  dermatoses,  erosions,  ulcerations,  infiltra- 
tions of  organs,  visceral  neoplasms,  etc.,  does  it  not  on  the 
other  hand  also  reveal  itself,  generally,  by  phenomena  of 
anaemia,  malnutrition,  emaciation,  impoverishment,  and 
organic  deterioration,  sometimes  also  by  nervous  troubles 
— in  a  word,  by  reactions  of  a  general  character  upon  the 
various  organs  ?  Does  not  syphilis,  as  M.  Eicord  so  justly 
declares,  awaken  scrofula  in  the  scrofulous  ?  Does  it  not 
also  awaken  dartre  in  the  dartrous,  as  our  lamented  col- 
league, M.  Bazin,*  taught  here?  Does  it  not  also  react 
upon  traumatic  lesions,  as  M.  Yerneuil  and  his  pupils  are 
now  in  a  fair  way  to  demonstrate  ?  f  Syphilis,  then,  is  not 
simply  a  disease  with  syphilitic  symptoms.  It  is  a  disease 
of  the  whole  system.  It  is  a  disease  which  creates  a  gen- 
eral disturbance  in  the  whole  organism,  which  affects,  or 
may  affect,  that  which  is  commonly  called  "the  health," 
which  awakens,  or  may  awaken,  very  diverse  morbid  ten- 
dencies— in  a  word,  it  is  a  disease  with  diversified  and 
polymorphous  reactions. 

N'ow,  if  this  is  the  case,  if  syphilis  is  capable  of  intro- 
ducing disturbances  so  profound,  and  at  the  same  time  so 
complex,  into  the  organism  which  it  affects,  what  is  there 
astonishing  in  heredity  reflecting  these  varied  morbid  dis- 
positions in  the  product  of  conception,  in  the  child,  the 
offspring  of  syphilitic  parents  1 

However,  let  us  leave  these  theoretical  discussions  and 
consider  only  what  observation  and  the  clinic  teach  us. 

The  clinic  teaches  us  that  children  born  of  syphilitic 
parents  are  exposed  to  certain  morbid  conditions,  to  cer- 

*  See  Lemons  iMoriques  ei  cliniqucs  sur  la  syphilis  et  les  sypJdlides,  second  edition, 
Paris,  1866. 

f  See  Henri  Petit,  De  la  syphilis  dans  ses  rapports  avec  le  traumatisme. —  Tlihes 
de  Paris,  1875.  Tiie  reader  will  find  in  this  estimable  work  a  very  complete  his- 
tory of  the  subject. 


MIXED  HEREDITY.  55 

tain  morbid  aptitudes  wMch  are  produced  in  them  witli  a 
significant  frequency. 

Let  us  proceed  to  precise  facts. 

These  children  are  very  frequently  remarkable,  almost 
recognizable,  I  may  say,  by  their  native  debility.  They 
come  into  the  world  small,  singularly  weak  and  puny, 
poorly  developed,  wrinkled  and  shriveled,  stunted,  with 
the  "  old  man  look,"  as  it  is  usually  termed.  One  would 
call  them  old  people  in  miniature,  with  a  skin  too  large 
for  them  over  certain  points.  Sometimes,  again  (a  particu- 
lar sign  to  which  I  call  your  attention),  they  present  on 
the  anterior  surfaces  of  the  legs  a  condition  of  sub-oedem- 
atous  puffiness  of  the  integument,  which  no  longer  glides 
over  the  subjacent  parts,  1but  which  seems  to  be  united  to 
the  cellular  tissue  and  the  aponeurotic  tissues  of  this 
region.  Nothing  else,  however,  of  a  special  character 
attests  a  well-pronounced  syphilitic  state  in  these  chil- 
dren, these  little  old  people,  as  they  are  called ;  nothing 
else  indicates  the  existence  of  any  other  malady.  And, 
nevertheless,  at  the  first  glance,  one  Judges  correctly  that 
they  will  not  live.  Even  the  nurses  do  not  make  a  mis- 
take in  this  respect.  I  have  known  many  to  refuse  such 
nurslings,  because,  they  said,  "they  would  not  succeed  in 
raising  them."  Scarcely,  in  fact,  have  these  children  the 
strength  to  nurse  ;  "they  do  not  draw,"  their  mothers  or 
their  nurses  repeat  to  you ;  they  sleep  upon  the  breast. 
Then  they  become  more  and  more  feeble,  and  soon  your 
first  previsions  are  confirmed.  These  children  do  not  die, 
properly  speaking ;  they  fade  out  rather  than  die ;  they 
cease  to  live,  for  the  sole  reason  that  they  are  not  viable, 
that  they  are  unequal  to  life  on  account  of  the  functional 
insufiaciency  of  their  organs. 

2..  At  other  times  (and  here  I  am  going  to  reproduce  a 


56  SYPHILIS  AND  MARRIAGE. 

pathological  fact  wMch  I  have  alluded  to  in  a  preceding 
chapter) — at  other  times,  I  say,  these  children  present  more 
favorable  appearances.  They  come  into  the  world  feebly 
constituted,  without  doubt,  but,  on  the  whole,  with  an 
average  or  passable  development,  which  permits  us  to 
consider  them  viable.  We  have  reason  to  hope  that  with 
care  and  a  good  nurse  they  will  "pull  through,"  as  is  the 
case  with  so  many  other  new-born,  who,  feeble,  puny,  and 
delicate  at  first,  soon  develop  and  become  strong  in  the 
course  of  the  fii'st  weeks.  And,  in  reality,  these  children 
continue  to  live  without  accidents  and  without  apparent 
disease.  Then,  after  some  days,  after  some  weeks,  sud- 
denly they  commence  to  pine  away,  and  rapidly  fade  out 
without  an  attack,  without  apparent  reason,  without  any 
morbid  incident  superadded.  Sometimes,  even,  as  I  have 
already  remarked  to  you,  they  die  in  a  moment,  in  a  man- 
ner the  most  unexpected,  the  most  unlooked  for,  without 
their  parents  and  physicians  knowing  how  and  wherefore 
this  sudden  death  is  produced.  I  have  now  among  my 
notes  more  than  half  a  score  of  cases  of  this  kind,  and,  as 
an  example,  you  will  permit  me  to  cite  the  following, 
which  I  observed  with  the  cooperation  of  one  of  our  most 
distinguished  and  well-known  accoucheurs  : 

A  young  man  contracts  syphilis  and  is  not  treated  for 
it,  or  is  treated  in  an  ephemeral  fashion,  altogether  insuf- 
ficient. Some  time  afterward  he  marries.  His  wife  be- 
comes pregnant  almost  immediately.  During  the  course 
of  her  pregnancy  she  begins  to  be  affected  with  the  various 
phenomena  of  secondary  syphilis.  She  is  confined  almost 
at  term  of  an  infant  of  average  size,  passably  developed, 
and  free  from  every  ai^jDarent  sign  of  syphilis.  ISTursed 
by  its  mother,  attended  by  my  colleague  and  myself,  this 
child  grows  regularly  for  several  weeks  without  presenting 


MIXED  HEREDITY.  57 

the  least  morbid  symptom,  syphilitic  or  otherwise.  AU 
appears  to  go  well,  at  least  relatively,  when  one  morning 
we  learn  that  the  child  suddenly  succumbed  during  the 
night.  The  evening  previous  it  had  been  examined  by  my 
colleague,  who  had  found  it  in  a  quite  satisfactory  condi- 
tion. One  hour  before  its  death,  its  mother  had  held  it  in 
her  arms  and  changed  its  diapers  "  without  remarking  any- 
thing unusual."  In  brief,  death  occurred  in  a  manner  ab- 
solutely sudden  and  unexpected. 

!N"ote  well,  gentlemen,  these  cases  of  inexplicable  sud- 
den deaths  not  preceded  by  any  apparent  morbid  phenom- 
enon. You  will  certainly  encounter  them  in  practice,  for 
they  are  by  no  means  rare.  Many  accoucheurs  among  my 
colleagues  or  friends  have  told  me  that  they,  like  myself, 
have  observed  them,  and  almost  always  in  "  children  syph- 
ilitic or  the  issue  of  syphilitic  parents."  Here,  then,  is  a 
fact  which  I  commend  to  your  attention. 

3.  In  other  cases,  children  born  of  syphilitic  fathers 
and  mothers  escape  both  death  and  syphilis.  But  they 
present  themselves  with  a  wretched  appearance,  with  a 
poor  and  debilitated  constitution,  with  a  condition  of 
anaemia,  persistent  and  rebellious  to  aU  treatment,  with 
a  vital  resistance  inferior  to  the  normal  average.  One 
has  a  presentiment,  at  a  glance,  that  they  will  readily 
yield  to  a  slight  disease,  that  they  are  subjects  predis- 
posed to  what  is  called  the  malignity,  the  occult  in- 
sidiousness,  of  diseases.  And,  in  reality,  they  are  often 
carried  off  by  maladies  which  could  have  been  easily 
controlled  in  subjects  with  a  better  established  health 
and  a  more  vigorous  temperament. 

4.  Another  point  of  which  I  am  convinced  is,  that 
children,  sprung  from  syphilitic  ancestors,  present  a  de- 
cided predisposition  to  affections  of  the  nerwus  system. 


5,8  SYPHILIS  AND  MARRIAGE. 

A  very  large  number,  for  example,  die  from  convulsions. 
In  examining  my  individual  observations,  I  find  no  fewer 
than  fifty  cases  wliere  children  born  in  these  conditions, 
whether  syphilitic  or  not,  suddenly  died  in  the  course  of 
one  or  more  convulsive  attacks.  And,  on  the  other  hand, 
numbers  of  cases  of  the  same  character  are  found  signal- 
ized in  special  treatises  or  in  periodical  publications. 

Again,  these  same  children  are  powerfully  predisposed 
to  meningitis.  This  is  a  remark  which  I  made  long  ago, 
and  I  have  not  been  the  only  one  to  make  it.*  I  should 
not  be  surj)rised  if  the  pretended  successes  of  iodide  of 
potassium  in  tubercular  meningitis  (some  cases  of  this  kind 
have  been  published,  as  you  are  aware)  were  explicable  by 
the  specific  character  of  the  lesions  for  which  this  remedy 
was  administered. 

In  its  acute  forms,  this  meningitis  of  the  children  of 
syphilitic  parents  is  almost  invariably  fatal.  In  its  mild, 
progressive  forms,  it  may  spare  the  life,  only  to  end,  most 
generally,  in  a  state  of  intellectual  incapacity,  bordering 
on  imbecility  or  idiocy.  You  may  be  sure  that  many 
children,  backward,  imbecile,  or  idiotic,  are  nothing  else 
than  the  products  of  syphilitic  heredity. 

I  have  under  observation  at  this  moment  an  example 

*  At  the  moment  I  was  reading  the  proofs  of  this  volume,  chance  furnished  me 
a  new  and  deplorable  example  of  this  hereditary  influence  of  syphilis  in  the  pro- 
duction of  meningitis. 

One  of  our  most  distinguished  confreres  from  the  country  came  to  pay  me  a 
friendly  visit.     The  conversation  turned  upon  one  of  our  mutual  friends,  a  physician 

like  ourselves.     "  You  remember  well,"  my  confrlre  said,  "  poor  Dr.  X ,  that  we 

have  both  treated  for  a  grave,  persistent  syphilis  ?  Well,  he  has  just  lost  his  third 
child,  which  succumbed,  from  meningitis,  like  the  first  two.  He  has  no  doubt — nor 
have  I,  for  that  matter — that  these  successive  meningites,  which  have  carried  off 
all  his  children,  are  the  remote  results  of  his  old  diathesis.  .  .  .  However,"  added 
my  confrere,  "  I,  for  my  part,  firmly  believe  in  the  hereditary  influence  of  syphilis 
as  a  cause  of  meningitis  among  infants.  I  have  seen  too  many  cases  in  my  practice 
not  to  be  convinced  upon  this  subject." 


MIXED  HEREDITY.  69 

of  the  kind,  wMch  is  too  complete  and  too  demonstrative 
for  me  to  resist  the  desire  to  relate  it  to  you.  A  child  is 
born  of  a  syphilitic  father  and  mother,  who  have  already 
engendered  two  syphilitic  children,  both  soon  dying. 
From  the  first,  it  does  not  develop  physically  ;  its  growth 
is  retarded  ;  so  that,  at  twelve  years  of  age,  you  would  take 
it  for  a  child  of  six  years  at  most.  Toward  his  thirteenth 
year  he  becomes  unintelligent,  obtuse,  as  if  foolish ;  he 
forgets  the  little  that  he  knew ;  he  loses  his  memory ; 
he  can  scarcely  find  words  to  speak.  He  falls  into  a  sort 
of  torpor.  Then  occurs  an  acute  crisis  of  encephalo- 
meningitis,  vomitings,  obstinate  constipation,  strabismus, 
delirium,  partial  convulsions,  tremors,  epileptiform  at 
tacks,  alternating  with  long  periods  of  resolution  and  of 
coma,  paralyses,  contractures,  etc.  Specific  medication 
(iodide  of  potassium  and  mercurial  frictions),  although 
administered  very  tardily,  dissipates  all  these  morbid 
symptoms  with  a  significant  rapidity.  But  his  intelligence 
is  not  reestablished.  Far  from  this,  it  remains  abolished, 
extinguished,  annihilated  in  every  sense  of  the  word  ;  so 
completely,  that  the  child  is  to-day  no  more,  to  speak 
definitely,  than  a  veritable  idiot* 

It  is,  to  my  mind,  no  less  evident  that  the  hereditary 
syphilitic  influence  (even  limited  to  the  father  alone)  con- 
stitutes a  predisposition  to  hydrocepJialus.  This  is  at- 
tested by  a  number  of  facts  which  I  have  had  occasion  to 
record  in  my  practice.     I  could  cite,  among  others,  the 

*  I  have  from  my  colleague  and  friend,  Dr.  Tarnier,  a  case  of  congenital  idiocy 
in  a  child  born  from  a  syphilitic  father.  "  From  the  earliest  period  of  its  life," 
says  this  learned  accoucheur,  "  the  strange  aspect  and  the  general  condition  of  the 
child  had  directed  my  attention  toward  the  search  of  a  syphilitic  etiology,  although 
nothing  special  justified  this  suspicion.  I  interrogated  the  father  with  this  view, 
and  was  informed  by  him  that  he  had  contracted  syphilis  but  a  short  time  before 
his  marriage,  and  had  been  treated  for  it  in  a  very  insufficient  manner  only."  And 
also  other  similar  cases,  which  I  could  produce. 


60  SYPHILIS  AND  MARRIAGE. 

case  of  one  of  my  patients,  who,  having  had  the  impru- 
dence to  contract  a  marriage  despite  a  syphilis  not  treated, 
has  had  three  hydrocephalic  children  in  succession.  I 
should  add  that,  in  my  investigation  of  this  subject,  I  have 
encountered  here  and  there,  scattered  thi'ough  medical 
literature,  numerous  observations  of  the  same  character. 

5.  Finally,  there  rises  the  question  of  lympliatism  and 
scrofula,  which,  by  certain  authors,  are  regarded  as  only 
disguised  forms  of  hereditary  syphilis. 

Assuredly,  it  would  be  a  great  exaggeration  to  regard 
scrofula  as  a  degeneration  of  syphilis.  Assuredly,  it  would 
be  a  serious  error,  from  a  pathological  point  of  view,  to 
make  it  subordinate  to  syphilis,  to  consider  it  in  the  light 
of  a  bastard,  transformed,  metamorphosed  syphilitic  affec- 
tion. Scrofula,  unquestionably,  has  no  need  of  syphilis 
in  order  to  exist.  It  exists  by  itself  alone,  or,  at  least,  it 
is  the  effect  of  causes  which  have  nothing  to  do  with  the 
syphilitic  virus.  Ordinarily,  we  encounter  scrofulous 
children  descended  from  parents  who  have  never  presented 
the  least  syphilitic  symptom. 

But,  on  the  other  hand,  it  is  no  less  certain  that  syph- 
ilis constitutes,  if  you  will  permit  me  the  expression,  one 
of  the  affluents  of  scrofula.  It  brings  its  contingent  to 
scrofula,  by  virtue  of  its  being  a  debilitating,  ansemiating 
disease,  a  disease  impoverishing  the  organism,  deteriorat- 
ing the  constitution,  ruining  the  vital  forces.  It  beckons 
scrofula  in  its  train,  it  predisposes  to  it  in  the  same  man- 
ner as  do  all  depressing  causes,  in  the  same  manner  as 
misery,  insufficient  alimentation,  captivity,  etc.  And  this 
action  which  it  exercises  upon  the  health  of  the  parents 
is  reflected  and  revealed  afterward  in  the  child,  by  mani- 
festations peculiar  to  lymphatism  in  general,  and  to  the 
highest  degree  of  lymphatism,  that  is,  scrofula. 


MIXED  UEREDITY.  Q\ 

Sucli  are,  to  speak  only  of  facts  well  established,  the 
states  or  morbid  aptitudes  wMcli  may  be  derived  from 
syphilis  as  hereditary  consequences.  Still,  I  am  far  from 
saying  to  you  all  that  I  think.  For  I  strongly  suspect 
that  syphilis  serves  as  the  origin  of  other  functional  or 
organic  disorders,  such,  for  example,  as  congenital  mal- 
formations, arrests,  retardations  or  deviations  of  de- 
velopment, spinal  curvatures,  deafness,  keratitis,  strabis- 
mus, etc.  But  I  pass  on  from  these  several  points,  which 
might  become  a  matter  of  dispute,  and  of  which  I  should 
not  have  the  right  to  speak  to  you  with  a  sufficient  degree 
of  certainty. 


CHAPTEE  yi. 

MATERNAL     HEKEDITY. 

Feom  what  precedes,  tliere  follows  this  general  con- 
clusion: Hereditary  influence  becomes  veritably  disas- 
trous when  both  father  and  mother  are  diseased. 

That  stated,  may  we  now  go  farther  ?  Is  it  possible  for 
us  to  distinguish  in  this  mixed  influence  that  which  is  due 
to  the  father  and  that  which  is  due  to  the  mother,  that  is 
to  say,  to  estimate  the  quotum,  if  I  may  so  express  it,  of 
the  hereditary  reaction  of  each  of  these  two  parents  upon 
the  foetus  ?  This  is  a  problem  more  than  difficult,  and  one 
which  it  would  be  impossible  to  solve  in  the  present  state 
of  our  knowledge,  for  the  numerical  data  which  would 
enable  us  to  institute  a  parallel  between  the  results  of 
paternal  heredity  and  maternal  heredity  exercised  sepa- 
rately are  wanting.  All  that  we  can  say  in  a  general  way, 
avoiding  a  more  minute  analysis,  is :  The  syphilitic  influ- 
ence derived  from  the  father  reacts  upon  the  child  in  only 
a  limited  number  of  cases,  while  the  syphilitic  influence 
derived  from  the  mother  is  exercised  upon  the  child  in  a 
manner  much  more  frequent,  much  more  active,  and  alto- 
gether much  more  dangerous.  A  child  born  of  a  syphilitic 
father  and  a  healthy  mother  has  numerous  chances  of 
escaping  both  death  and  syphilis,  and  the  indirect  conse- 
quences of  syphilis. 

On  the  contrary,  when  a  child  is  bom  of  a  syphilitic 


MATERNAL  HEREDITY.  63 

motlier,  tlie  father  being  free  from  syphilis,  it  has  but  a 
slight  chance  of  escaping  the  hereditary  influence,  in  what- 
ever form  it  may  be  exercised.  One  may  even  predict  that 
it  will  inevitably  die,  if  the  maternal  syphilis  is  of  recent 
date,  or  if  it  has  not  been  repressed  by  specific  treatment. 

It  may  be  said,  very  positively,  and  without  any  exag- 
geration, that  the  syphilitic  influence  of  the  mother  is 
NQY\\2h\j pernicious  for  the  foetus.* 

The  following  statistics,  collected  from  different  sources, 
and  which  I  intentionally  give  separately,  go  to  establish 
this  with  a  numerical  evidence  unfortunately  too  complete,  f 

I.  The  first  relates  to  syphilitic  women  observed  in  the 
city,  in  private  practice.  It  comprises  eighty-five  cases  of 
pregnancy,  which,  considered  only  in  their  result  the  most 
direct  and  the  least  subject  to  error,  viz.,  the  death  or  the 
survival  of  the  infant,  have  furnished  me  with  the  follow- 
ing figures : 

Cases  of  survival 27 

Cases  of  death  (abortions,  premature  accouchements,  infants 

still-born,  infants  dead  within  a  short  time  after  delivery)     58 

Total 85 

Thus,  in  eighty-five  births,  fifty-eight  deaths,  that  is  to 
say,  in  round  numbers,  more  tlian  two  cases  of  death  to 
enery  tTiree  MrtJis. 

A  lamentable  proportion,  to  be  sure,  but  much  smaller, 
nevertheless,  than  the  following. 

*  In  order  to  appreciate  the  isolated  influence  of  maternal  syphilis  upon  the 
foetus  in  an  absolutely  rigorous  manner,  it  will  be  necessary  to  consider  the  cases 
where  the  mother  alone  is  syphiUtic,  while  conversely  the  father  is  healthy.  Now, 
the  cases  of  this  kind  (especially  those  which  are  free  from  every  chance  of  error) 
are  very  rare  in  practice,  and  I  have  not  yet  succeeded  in  collecting  more  than  a 
small  number.  We  are,  then,  forced  to  confine  ourselves  to  a  parallel  between  the 
cases  in  which  the  mother  is  healthy  and  those  in  which  she  is  infected.  With 
the  first  we  are  already  familiar,  from  what  precedes,  and  we  are  now  about  to  see 
what  pertains  to  the  second. 

t  v.  Illustrative  Cases,  Note  III. 


64  ■  SYPHILIS  AND  MARRIAGE. 

II.  Our  second  statistics  have  been  recorded  of  patients 
observed  in  the  hospital,  for  the  most  part  at  the  Lourcine, 
some  at  the  Saint  Lonis. 

Let  us  explain  in  advance,  in  extenuation  of  the  unfor- 
tunate results  we  are  about  to  X3resent,  that,  in  the  patients 
of  this  second  series,  the  syi)hilitic  influence  was  mani- 
festly complicated  by  other  factors,  which  it  would  be  un- 
just to  ignore,  and  which  are  eminently  prejudicial  to  the 
success  of  pregnancy,  such,  for  example,  as  poverty,  pri- 
vations, irregular  and  insufficient  alimentation,  excessive 
labor,  fatiguing  vigils,  debauch,  and  often  professional 
debauch  (the  word  is  strictly  exact),  excess  of  every  kind, 
alcoholism,  lack  of  common  hygiene  and  special  treat- 
ment, etc.  Under  such  conditions,  it  is  evident  that  the 
mortality  of  the  children  is  destined  to  be  increased.  This 
is,  in  effect,  what  occurs,  but  in  proportions  assuredly 
much  larger  than  one  would  suppose. 

The  abstract  of  my  hosjoital  notes  gives  the  following 
results  in  167  cases  of  pregnancy  coincident  with  syphilis : 

Cases  of  survival  of  infant 23 

Cases  of  death  of  infant  (abortions,  accouchements  premature, 

still-born,  infants  dead  a  short  time  after  accouchement) . .   145 

Total 167 

145  deaths  among  167  bu^ths,  that  is  to  say,  in  round 
numbers,  only  one  infant  surmving  in  seven  to  eight 
MrtJis  !  What  a  monstrous  proportion  !  What  frightful 
mortality !  In  truth,  this  would  not  be  credited,  and  I 
myself  would  not  believe  it  if  I  had  not  under  my  eyes 
the  irrefutable  data  which  have  furnished  me  the  elements 
of  this  calculation.* 

*  It  will  not  be  useless,  I  think,  to  add  certaia  commentaries  upon  these  last 
statistics,  the  truly  frightful  results  of  which  demand  an  explanation.  In  the  first 
place,  the  larger  proportion  of  the  cases  upon  which  the  observations  are  based 


MATERNAL  HEREDITY.  65 

I  have  not  been  tlie  only  one,  moreover,  to  estalblisli 
the  foregoing  unfortunate  results.  In  this  same  theatre 
of  observation,  the  Lourcine,  Dr.  Coffin  arrives  at  figures 
much  more  dismal  still.  Thus,  in  28  pregnancies  of 
syphilitic  women  which  were  terminated  at  the  hospital, 
he  has  verified  this  : 

Infants  dead  (abortions,  accouchements  before  term, 

death  from  1st  to  45th  day) 37  cases. 

Infants  surviving 1  case  alone. 

Only  one  child  surviving  in  28  pregnancies !  What  a 
proportion !  * 

One  of  my  former  pupils,  Dr.  Le  Pileur,  at  present 
physician  of  Saint  Lazare,  at  my  request  has  kindly  ex- 
amined the  administrative  registers  of  Lourcine  for  a  period 
of  ten  years,  and  prepared  statistics  of  mortality  among 
children,  the  issue  of  syphilitic  mothers.  This  long  work 
has  given  the  following  results : 

1.  In  414  pregnancies,  154  were  terminated  either  by 
abortion  or  by  the  expulsion  of  still-born  infants  at  dif- 
ferent periods  of  gestation. 

have  been  collected  at  the  Lourcine,  that  is  to  say,  in  a  public  hospital  especially  for 
females,  composed  in  great  part  of  prostitutes,  making  a  business  of  debauch,  and 
addicted  to  all  excesses,  etc.  In  the  second  place,  I  ought  to  remark  that  almost 
all  the  patients  who  figure  in  these  statistics  were  women  affected  with  secondary 
syphilis  more  or  less  recent.  Consequently,  they  were  in  that  stage  of  the  diathesis 
which  is  the  most  pernicious  for  the  foetus.  Let  it  be  added  that  the  great  ma- 
jority of  them  had  never  followed  any  treatment,  at  least,  any  systematic  treat- 
ment, before  their  entrance  into  the  hospital.  And  more,  we  know  by  experience 
how  the  patients  at  the  Lourcine  behave  themselves — contriving  all  manner  of  ruses 
in  order  to  escape  a  mercurial  treatment,  quitting  the  hospital  when  scarcely  cured 
of  the  more  visible  accidents,  only  to  reenter,  and  again  leave ;  in  addition,  observ- 
ing no  regimen,  no  medication,  no  hygiene,  etc.  So  that,  without  fear  of  departing 
from  the  truth,  one  might  regard  the  preceding  statistics  as  constituted  by  cases  of 
syphilis  not  treated,  abandoned  to  its  own  evolution,  and  exercising  upon  the  prod- 
uct of  conception  the  fullness  of  its  destructive  influence. 

*  £tude  clinical  pour  servir  d  Vhistoire  de  Vinfiuence  de  la  syphilis,  du  traitement 
mercuriel,  ei  dcs  ulcerations  du  col  sur  la  grossesse. — TJieses  de  Paris,  1851. 


66  SYPHILIS  AND  MARRIAGE. 

2.  Of  260  infants  born  at  term  and  living,  141  died 
within  a  very  short  time  (only  22  survived  more  than  one 
month). 

Let  us  add  up.  This  makes  a  total  of  295  deaths  in 
414  pregnancies,  that  is  to  say,  in  round  numbers,  almost 
three  deaths  in  every  four  births. 

And  note  again  that,  among  these  children  considered 
here  as  "surviving,"  there  are  assuredly  a  certain  num- 
ber who  must  have  succumbed  later  directly  from  their 
disease.* 

Likewise,  again,  M.  Durac,  observing  at  Toulouse,  has 
seen,  in  46  pregnancies  of  syphilitic  women,  36  terminate 
fatally  to  the  infant,  f 

After  such  statistics,  all  commentary  would  be  super- 
fluous. It  is  only  too  evident  from  these  figures  that  the 
infection  of  the  mother  exerts,  or  may  exert,  upon  the  in- 
fant an  influence  the  most  active,  the  most  noxious,  the 
most  murderous.  So,  then,  as  regards  our  present  sub- 
ject, the  worst  danger  which  an  infant  to  be  born  from 
the  union  of  a  syphilitic  man  with  a  healthy  woman  can 
incur  is  for  this  woman  to  contract  the  infection  from 
her  husband,  since,  in  this  new  situation,  the  health  and 
life  of  the  infant  will  be  found  most  seriously  com^Dro- 
mised. 

And  thus,  gentlemen,  you  see  how  and  in  what  differ- 
ent ways  a  man  with  a  syphilis  not  eradicated,  contracting 
marriage,  may  become  dangerous  to  his  children. 

*  That  for  two  reasons :  1st,  because  hereditary  syphilis  most  often  only  makes 
its  invasion  some  weeks  after  birth,  that  is  to  say,  at  a  period  when  the  mother  and 
the  infant  may  have  already  quitted  the  hospital ;  2d,  because  numbers  of  patients 
of  the  Lourcine  insist  upon  demanding  their  discharge  when  they  see  that  their 
child  is  about  to  die,  "not  wishing,"  say  they,  "that  it  should  die  at  Lourcine" — 
not  wishing,  in  reality,  that  the  disease  of  the  said  child  should  testify  to  their 
presence  in  that  hospital. 

f  De  fldredite  de  la  syphilis. —  Theses  dc  Ifonipelier,  1866. 


CHAPTER  VII. 

PERSONAL   DANGERS   OF  THE  HUSBAlSrD. 

Third  Point. — A  man.,  who  enters  into  marriage.,  with 
a  syphilis  not  extinct,  may  become  dangerous  through 
himself  to  the  interests  of  his  family. 

^  In  other  words,  lie  may  become  dangerous  to  his  fam- 
ily by  reason  even  of  the  personal  dangers  to  which  he 
remains  exposed  from  his  disease,  from  his  persistent 
diathesis. 

With  this  third  point,  generally  neglected,  forgotten, 
sacrificed  —  I  can  not  explain  the  reason  why — we  are 
about  to  touch  upon  the  most  delicate  and  the  most  diffi- 
cult side  of  the  problem  which  we  are  now  considering. 
Here  there  are  no  longer  questions  of  pure  iDathology 
alone  that  we  have  to  examine  and  discuss.  Morality  is 
about  to  join  itself  and  enter  in  line.  Reassure  yourselves, 
however.  I  know  to  whom  I  speak,  and  I  will  not  waste 
my  time  nor  yours  in  preaching  to  the  convinced.  I  shall 
only  need  in  this  new  path  to  invoke  certain  principles, 
certain  obligations,  certain  duties  which  exist  inherent  in 
the  breast  of  every  honest  man,  which  are  unquestioned 
as  they  are  unquestionable ;  and,  at  the  proper  time,  I 
will  apply  them  to  our  subject  in  strict  measure,  where 
they  will  be  indispensable  to  it. 

Speaking  to  physicians,  I  have  not  to  remind  you,  by 


68  .  SYPEILIS  AND  MARRIAGE. 

way  of  premise,  tliat  syphilis  is  a  serious,  a  very  serious 
disease,  liable  to  end,  when  left  to  itself  or  insufficiently 
treated,  either  in  important  affections  or  in  serious  infir- 
mities ;  or  even  (frequently,  much  more  frequently  than  is 
stated  or  seems  to  be  believed)  in  a  termination  more  lam- 
entable still — in  death.  This  is  a  matter  of  common  no- 
toriety, almost  hackneyed.  But  what  I  wish  to  particu- 
larize, because  it  directly  concerns  our  present  subject,  is 
that,  save  exceptions  rare  and  of  a  special  order,  syphilis 
but  seldom  ends  in  serious  or  fatal  accidents  until  after  a 
remote  maturity,  that  is  to  say,  after  a  long  series  of  years, 
for  example,  after  ten,  fifteen,  twenty  years,  and  more.  It 
is,  as  you  know,  in  the  tertiary  period,  a  period  almost 
indefinite  in  duration,  that  the  grave  manifestations,  the 
veritable  catastrophes  of  the  pox,  occur.  That  is  to  say, 
syphilis,  ordinarily  contracted  in  the  foolish  years  of 
youth,  during  single  life,  has  its  grave  complications  only 
in  mature  life,  when  the  former  gay  youth  is  transformed 
into  a  serious  man,  is  metamorphosed  into  a  husband  and 
father.  Such  are  the  pathological  aspects  of  the  case,  are 
they  not  ? 

Now,  if  this  be  so,  remark  then,  I  beg  you,  what  be- 
comes the  situation  of  a  man  who,  with  a  syphilis  con- 
tracted in  his  youth  and  not  sufficiently  treated,  presents 
himself  for  marriage  under  such  conditions  ? 

The  situation,  medically,  is  that  of  a  man  who  has 
every  chance  to  be  exposed,  in  a  more  or  less  distant  fu- 
ture, to  the  assaults,  more  or  less  formidable,  of  the  diath- 
esis. The  situation  is  that  "^'im  malade pour  Vavenir,^^ 
if  I  may  thus  express  it,  that  of  a  man  with  health  com- 
promised, of  a  man  damaged  physically,  indebted  to  the 
pox,  and  destined,  sooner  or  later,  to  discharge  that  debt. 

In  such  conditions,  is  it  admissible  that  this  man  should 


PERSONAL  DANaERS  OF  THE  HUSBAND.  69 

aspire  to  marriage?  Is  it  honest,  is  it  moral  that  this 
"future  sick  man"  should  think  of  becoming  a  husband 
and  a  father?  And,  if  he  consults  us,  as  physicians,  to 
know  whether  he  is  fit  for  marriage,  can  we,  ought  we 
to  allow  him  to  engage  in  this  undertaking  upon  our  own 
responsibility  ?  No  ;  it  is  not  admissible  ;  it  is  not  honor- 
able ;  it  is  not  moral  for  a  syphilitic  subject  to  contract 
a  marriage  in  the  conditions  we  have  Just  specified.  And, 
when  he  comes  to  ask  our  advice,  our  duty  is  to  enlighten 
him  upon  this  subject,  to  refuse  him  the  authori^;ation, 
the  free  patent — ^permit  the  word — which  he  comes  to  claim 
from  us,  a^nd  to  explain  to  him  this  refusal  for  the  reasons 
which  we  are  about  to  indicate. 

What,  then,  is  marriage  in  its  completeness,  gentlemen  ? 
Marriage  is  not  only  an  affair  of  sentiment,  of  passion, 
of  convenience,  and  of  interests.  To  consider  it  from  a 
stand-point  more  practical,  and  at  the  same  time  more  ele- 
vated, marriage  is  an  association  freely  entered  into,  where 
each  contracting  party  is  pledged  to  bring  in  good  faith  a 
share  of  health  and  physical  vigor,  with  the  view  of  co- 
operating, on  the  one  hand,  for  the  material  prosperity  of 
the  family,  and,  on  the  other  hand,  for  the  raising  of  chil- 
dren— ^the  supreme  and  sacred  end  of  every  union. 

Now,  what  in  this  case,  I  ask  of  you,  will  be  the  share 
contributed  to  the  partnership  by  a  husband,  syphilitic, 
and  not  cured  of  his  syphilis.  His  share  will  be  that  of  a 
health  compromised,  hypothecated,  burdened  with  a  debt 
(I  again  use  the  word  designedly)  hereafter  due  the  pox, 
that  pitiless  creditor. 

On  account  of  the  pox,  it  may  happen  that  this  man 

may  experience  one  day  or  another  such  and  such  serious 

affections  which  will  ruin  his  health  ;  such  and  such  an 

infirmity  which  will  render  him  incapable  of  work,  inca- 
6 


70    ■  SYPHILIS  AND  MARRIAOE. 

pable  of  earning  his  daily  bread.  And  then  what  will  be- 
come of  the  family  of  which  this  man  is  the  recognized 
support  ?  What  will  become  of  his  wife  ?  What  will 
become  of  his  children?  On  account  of  the  i)ox,  also, 
this  man  may  die.  What  may  happen,  he  being  dead, 
to  this  wife  and  to  these  children?  Is  it  admissible, 
then,  that  a  man  should  think  of  creating  for  him- 
self a  family  when  he  is  liable  to  fail  this  family?  Is 
it  admissible,  is  it  right,  is  it  moral  that  a  man  should 
dream  of  having  a  wife  and  children  when  he  offers  the 
possible  prospect  of  widowhood  to  this  wife,  of  oi-phanage 
to  these  children,  of  poverty  to  this  family  ?  No,  a  hun- 
dred times  no  !  Also,  and  I  do  not  hesitate  to  say  it,  the 
man  who,  syphilitic  and  not  cured  of  his  syphilis,  fears 
not,  nevertheless,  to  append  his  signature  to  the  marriage 
contract,  commits  at  this  moment  a  base  act,  an  act  im- 
moral and  corrui)t,  an  act  which  good  people  ■wdll  be  unan- 
imous in  condemning. 

A  comparison  will  confirm  my  idea  by  embodying  it  in 
a  common  illustration  :  Two  individuals  associate  their  in- 
terests, let  us  suppose,  in  some  bu^siness,  whatever  it  may 
be.  One  contributes  his  partnership  share  in  good  money 
or  in  good  values  ;  the  other,  T\dthout  the  knowledge  of 
the  first,  furnishes  his  share  in  values,  doubtful,  hypothe- 
cated, adulterated,  stamped  with  an  inevitable  deprecia- 
tion of  market  value  in  the  future.  What  think  you  of 
the  action  committed  by  the  latter  ?  Well,  the  last  is  our 
syphilitic,  who  brings  into  the  partnership  of  marriage 
a  depreciated  health,  a  health  of  j)oor  quality,  if  I  may 
thus  express  it,  with  the  prospect,  certain  or  probable, 
of  pathological  catastrophes,  compromising,  or  capable 
of  compromising  at  a  given  time,  the  material  interests  of 
the  association. 


PERSONAL  DANGERS  OF  TEE  HUSBAND.  71 

In  the  two  cases,  the  form  of  the  arrangement  is  very 
different,  assuredly,  but  the  principle  remains  the  same, 
and  there  is  the  same  immorality  in  both.  And  do  not 
accuse  me  here,  gentlemen,  of  exaggeration.  Do  not  think 
that,  for  the  requirements  of  my  cause,  I  designedly  em- 
phasize the  situation  and  darken  the  picture.  It  is  not  so. 
I  speak  after  what  I  have  seen,  exclusively,  and  without 
fantastic  additions.  Unfortunately,  it  is  only  too  true 
that,  even  from  the  sole  point  of  view  from  which  we 
are  speaking,  even  from  the  sole  point  of  view  of  the 
personal  dangers  of  the  husband,  the  pox  is  a  frequent 
source  of  social  miseries  the  most  lamentable,  of  domestic 
dramas  the  most  heart-rending.  If  you  doubt  it,  I  have 
the  wherewithal  to  convince  you.  I  open  my  notes  and  I 
copy  from  life  :  A  young  man  marries  some  years  after  a 
syphilis  very  negligently  treated.  Six  months  after  his 
marriage  he  is  seized  with  cerebral  accidents  of  a  specific 
nature.  He  dies,  leaving  a  wife  and  a  young  child  in  ab- 
solute destitution. 

An  artist  formerly  very  well  known,  and  quite  cele- 
brated on  the  stage,  marries,  despite  a  syphilis  which  had 
never  been  otherwise  treated  (the  expression  is  his)  than 
"by  contempt."  He  has  the  good  fortune  not  to  infect 
his  wife,  and  to  have  a  healthy  child.  But,  some  years 
later,  he  begins  to  be  affected  with  a  tuberculo -ulcerative 
syphilide,  which,  still  treated  with  the  same  stupid  indif- 
ference, takes  on  a  phagedenic  character,  plows  up  the 
whole  face,  then  destroys  entirely  the  nose  and  the  upper 
lip,  then  penetrates  into  the  nasal  fossae,  and  devours  the 
whole  internal  bony  structure  of  this  cavity,  the  entire 
palate,  the  soft  j)alate,  the  pharynx,  etc.  This  unfortu- 
nate man  thus  becomes  a  hideous  and  infected  monster, 
an  object  of  horror  and  disgust  to  all  who  approach  him. 


72  SYPHILIS  AN'D  MARRIAGE. 

He  drags  along  thus  many  years  in  a  condition  more  and 
more  frightful,  before  ending  in  a  death  that  to  him  came 
too  slowly.  What  a  situation !  What  a  spectacle  for  a 
young  wife,  for  a  child,  for  a  family ! — without  speaking 
of  moral  punishment,  and  of  pecuniary  ruin. 

Another  artist,  this  one  a  painter,  full  of  talent  and  of 
promise,  marries,  with  a  syphilis  very  insufficiently  treat- 
ed. All  goes  well  during  several  years.  The  pictures  sell, 
the  little  household  prospers,  and  is  enriched  with  a  child. 
Then  the  husband  has  an  inflammation  of  the  eyes,  the 
nature  of  which  is  at  first  misapj)rehended,  and  which, 
attacked  too  tardily  by  specific  medication,  tenninates  in 
complete  blindness.  Consequence  :  family  ruined,  falling 
into  absolute  indigence,  and  forced  to  inscribe  themselves 
at  the  bureau  of  charity  in  order  not  to  perish  of  hunger. 

A  young  man  comes  to  consult  me  for  various  accidents 
resulting  from  a  neglected  syphilis.  I  treat  him,  and  all 
disappears.  Some  months  later,  in  spite  of  all  my  advice 
and  remonstrances,  he  marries.  Twelve  days  after  his 
marriage,  on  his  wedding  journey,  he  is  seized  with  a  vio- 
lent epileptic  attack,  the  first  symptom  of  a  cerebral  syph- 
ilis, which  is  soon  emphasized  by  troubles  of  intelligence, 
and  left  hemiplegia.  IN'otwithstanding  all  my  care,  he 
succumbs  some  months  later,  leaving  his  young  wife  en- 
ceinte. 

A  student  of  medicine  acquires  syphilis,  and  judges  it 
proper  to  treat  himself  exclusively  with  the  iodide  of  po- 
tassium, not  being  willing  to  take  mercury.  A  short  time 
after  his  doctorate  he  marries.  Some  years  later  he  is  af- 
fected with  a  slight  paraplegia,  which  is  referred  to  syphi- 
lis by  common  consent  of  all  the  physicians  whom  he  con- 
sults. ^Notwithstanding,  he  still  treats  himself  in  a  very 
irregular  fashion,  "  by  fits  and  starts,"  using  his  own  ex- 


PERSONAL  DANGERS  OF  TEE  HUSBAND.  73 

pression.  Finally,  lie  becomes  absolutely  paralyzed  in 
the  legs,  and  I  find  him,  when  he  presents  himself  to  me, 
in  a  state  of  absolute  incurability.  Judge  of  the  situation 
of  our  unfortunate  confrere  when  you  learn  that,  without 
resources,  he  remains  infirm,  with  the  charge  of  a  decrejjit 
mother,  a  wife,  and  two  young  children  ! 

A  young  business  man  contracts  syphilis,  and  is  treat- 
ed quite  regularly  for  some  months.  Relieved  from  all 
apparent  manifestations  of  the  disease,  he  believes  him- 
self out  of  danger  and  discontinues  all  treatment.  Three 
years  later,  without  consulting  a  physician,  he  marries. 
Scarcely  married,  he  communicates  syphilis  to  his  wife  by 
a  relapse  of  secondary  accidents  which  occur  on  the  penis. 
Then  he  is  attacked  with  symptoms  of  cerebral  syphilis, 
which  I  succeed  in  subduing  at  first,  but  which  make  a 
new  invasion  and  rapidly  carry  off  the  patient. 

Epilogue. — The  young  wife,  becoming  enceinte  at  the 
beginning  of  her  marriage,  brings  forth  a  syphilitic  infant 
which  an  active  medication  succeeds  in  saving.  Yery  soon 
she  presents  multiple  symptoms  of  malignant  syphilis — 
confluent  eruptions,  cephalalgia,  violent  neuralgias,  ec- 
thymatous  eruptions  with  phagedenic  tendency,  repro- 
ducing themselves  when  scarcely  cured,  and  ending  in 
covering  the  body  with  monstrous  sores.  Under  the  in- 
fluence of  such  symptoms,  her  health  is  altered:  ema- 
ciation, decline  of  strength,  loss  of  appetite,  digestive 
troubles,  diarrhoea,  finally  pulmonary  tuberculosis,  and 
death  from  the  cachexia — an  orphan  and  without  re- 
sources, the  child  has  to  be  relieved  by  public  charity. 

A  last  example — for  I  could  not  finish  them  if  I  chose 
to  recount  all  the  miseries  of  this  kind  which  I  have  wit- 
nessed.'* 

*  At  the  moment  that  I  write  these  lines,  a  new  and  very  sad  example  of  the 


74  SYPHILIS  AND  MARRIAGE. 

A  manufacturer  marries,  notwithstanding  a  syphilis 
very  negligently  treated.  Thanks  to  his  knowledge  of 
business  and  the  rich  dowry  of  his  wife,  he  founds  a  great 
manufactory,  which  prospers  marvelously.  Some  years 
later  he  is  affected  with  gummy  periostoses  and  exostoses 
of  the  cranium.  There  come  on  gradually  cerebral  mani- 
festations of  various  forms  :  intellectual  troubles,  vertigo, 
epileptiform  attacks,  hemiplegia.  He  then  compromises 
his  fortune  and  his  commercial  honor  in  grandiose  and 
adventurous  operations  which  he  is  no  longer  capable  of 
directing,  or,  to  speak  more  correctly,  he  would  not  have 
undertaken  in  a  sound  state  of  his  reasoning  faculties,  and 
he  is  ruined.  Finally,  he  falls  into  dementia  and  dies, 
leaving  his  wife  and  four  young  children  in  a  destitute 
condition. 

What  is  to  be  said,  gentlemen,  of  such  things,  such 
social  calamities  ?  And  what  is  to  be  said  of  those  who 
have  caused  them,  who,  after  all,  are  the  responsible 
authors  ?  In  their  extenuation,  let  us  admit  that  they  have 
been  more  ignorant,  more  imprudent,  than  culpable  ;  let 
us  admit  (for  this  is  true  in  the  great  majority  of  cases)  that 
they  were  not  conscious  of  the  injury  they  might  occa- 
sion others,  of  the  misery,  of  the  disasters  which  they  ran 
the  risk  of  spreading  around  them.  But  their  "victims  are, 
on  this  account,  none  the  less  sad  examples  of  the  terrible 

same  order  has  just  presented  itself  to  me.  Summoned  within  a  few  days  to  a 
consultation  in  a  lunatic  asylum,  I  found  there  a  young  man  affected  with  a  grave 
cerebral  syphilis,  and  a  prey  to  the  most  violent  delirium.  His  condition  was  such 
as  to  leave  little  ground  for  hope.  Now,  the  history  of  this  patient  is  traced  in 
that  of  all  the  subjects  that  we  have  just  been  considering.  At  nineteen  years 
he  contracted  the  pox,  and  was  treated  for  it  only  just  long  enough  to  dissipate  the 
apparent  manifestations.  Later,  he  married  (about  sixteen  months  since),  notwith- . 
standing  his  syphilitic  antecedents.  He  became  a  father  about  a  month  ago. 
Being  without  means,  he  was  dependent  upon  his  labor.  What  a  situation  for  his 
wife,  what  a  future  for  his  child ! 


PERSONAL  DANGERS  OF  THE  HUSBAND.  T5 

consequences  which  may  result  from  their  indifference, 
their  recklessness,  their  thoughtlessness.  Well,  at  any 
rate,  let  not  these  lamentable  examples  be  lost ;  let  them 
serve  as  lessons  to  show  us  our  professional  duty,  or, 
rather,  the  social  duty  which  devolves  upon  us  under  such 
circumstances.  And  this  duty,  which  you  have  antici- 
pated, is  this : 

If  it  is  not  the  province  of  men  of  the  world  and  of 
patients  to  know  what  the  effects  of  the  pox  not  treated 
may  be,  after  a  long  interval,  it  is  our  province  to  know 
this  and  to  instruct  those  who  are  ignorant.  It  is  our 
mission  to  enlighten  upon  this  point  patients  who  come  to 
us,  and,  more  especially  still,  those  who  come  to  consult 
us  upon  the  propriety  of  marriage,  notwithstanding  a 
syphilis  insufficiently  treated,  and  which  remains  mena- 
cing for  the  future.  It  is  our  mission  to  divert  from  mar- 
riage every  patient  who  presents  himself  to  us  under  such 
conditions,  to  dissuade  him  from  it  to  his  own  great  ad- 
vantage and  to  the  great  advantage  of  others,  to  show  him 
the  abyss  about  to  open  under  his  feet,  to  reveal  to  him 
the  dangers  to  which  he  would  expose  his  future  family 
by  a  premature  union,  and  to  say  to  him,  finally,  this, 
with  the  authority  of  our  science  and  our  character :  "  IN'o, 
sir,  no  ;  it  is  not  allowable,  in  your  present  condition,  for 
you  to  dream  of  marriage,  considering  only  the  personal 
risks  to  which  you  remain  exposed  from  your  old  disease. 
Until  now  you  have  thought  it  best  to  live  with  the  pox, 
to  preserve  the  pox.  That  was  your  right,  and  no  one  had 
anything  to  say,  for  you  were  single  and,  consequently, 
alone  liable  for  your  imprudence.  But  now,  since  you 
aspire  to  marriage,  the  situation  becomes  very  different. 
To  marry  is  to  have  charge  of  lives  ;  and,  since  you  do  me 
the  honor  to  consult  me,  you  make  it  my  duty  to  remind 


76-  SYPHILIS  AND  MARRIAGE. 

you  that  yon  have  not  the  moral  right  to  associate  others 
in  your  personal  risks — that  is  to  say,  to  make  a  wife  and 
childi'en  share  the  possible  consequences  of  your  disease." 

Here  terminates,  gentlemen,  the  first  part  of  this  expo- 
sition. 

I  have  told  you  how  a  syphilitic  man  may  be,  or  may 
become,  dangerous  in  marriage.  I  have  endeavored  to 
show  you  that  he  may  be  dangerous  in  a  triple  manner : 
to  his  wife,  in  transmitting  to  her  the  disease  with  which 
he  is  affected ;  to  his  children,  by  way  of  heredity ;  to  his 
family,  from  the  personal  risks  to  which  he  remains  ex- 
posed. 

This  will  serve  us  as  a  point  of  departure  and  a  basis 
for  the  discussion  which  we  are  now  about  to  open.  From 
what  precedes,  the  natural  conclusion  is  : 

1.  That  marriage  should  be  forbidden  to  every  man 
who  still  presents  a  syphilis  sufficiently  active  to  be  dan- 
gerous. 

2.  That,  conversely,  it  may  be  permitted  to  every  man 
in  the  opposite  conditions. 

But  such  general  facts  are  not  sufficient  for  the  solu- 
tion of  the  essentially  practical  problem  which  we  are 
discussing.  It  is  necessary  that  we  now  grasp  the  ques- 
tion more  closely,  that  we  descend  to  details,  and  search 
out  the  clinical  elements  from  which  we  may  be  able  to 
judge  whether  a  syphilitic  subject  has  or  has  not  ceased 
to  be  dangerous  in  marriage,  and  whether  we  should  ac- 
cord him  the  authorization  which  he  comes  to  claim  from 
us,  or  flatly  place  our  veto  upon  his  projects  of  a  union. 


CHAPTER  VIII. 

COJSTDITIOlSrS  OF  ADMISSIBILITY  TO  MAEEIAGE  —  ABSENCE 
OF  EXISTING  SPECIFIC  ACCIDENTS — ^ADVANCED  AGE  OF 
THE  DIATHESIS. 

GrENTLEMEN" :  The  natural  order  of  our  subject  now 
leads  me  to  tlie  discussion  of  the  following  question  : 

In  what  conditions  does  a  patient  affected  with  syphilis 
cease  to  be  dangerous  in  marriage  ?  or,  what  amounts  to 
the  same  thing,  in  what  conditions  does  he  become  ad/mis- 
sible  to  marriage^  if  I  may  thus  express  it  ? 

ISTow,  as  we  have  been  hitherto  unrestrained  in  our 
progress  toward  determining  the  perils  which  affect  a 
syphilitic  man  in  marriage,  and  in  stating  theoretically  the 
general  principles  of  the  admissibility  or  of  the  non-admis- 
sibility  to  marriage  from  a  medical  point  of  view,  so  now, 
in  passing  from  theory  to  practice,  we  are  about  to  en- 
counter embarrassment  and  difficulties  in  appreciating  the 
variable  conditions,  multiple  and  complex,  of  particular 
cases. 

And  this  embarrassment,  these  difficulties,  we  shall 
experience  so  much  more  iDointedly,  as  we  are  now  tread- 
ing upon  ground  not  yet  cultivated.  The  experience  of 
our  seniors,  of  our  predecessors,  of  those  whom,  with  just 
respect,  we  regard  as  the  masters  of  our  art,  is  almost 
entirely  wanting  here.     And,  in  fact,  gentlemen,  you  may 


78  ■  SYPHILIS  AND  MARRIAGE. 

run  througli  the  classical  works,  you  may  examine  the 
special  treatises,  but  you  will  nowhere  find  this  gi-ave 
question  of  the  marriage  of  syphilitics  confronted,  dis- 
cussed, debated.  Without  doubt,  you  will  find  here  and 
there  certain  general  hints,  certain  indications— always  ' 
more  or  less  vague — incidentally  thrown  out  upon  this 
subject.  But  nowhere,  I  assure  you  from  my  o^ti  experi- 
ence, Avill  you  encounter  a  veritable  programme  formulated 
in  extenso,  or  even  outlined,  upon  this  matter.  All  re- 
mains to  be  done,  or  very  nearly  so,  and  this  constitutes 
by  no  means  the  least  embarrassment  of  him  who  has  the 
honor  to  now  address  you.* 

Let  us  venture,  nevertheless,  to  attack  this  difficult  and 
perilous  problem,  taking  for  guides,  on  the  one  hand,  the 
principles  which  we  have  established  in  our  preceding  lec- 
tures, and,  on  the  other  hand,  the  results  furnished  by  the 
clinic.  In  my  opinion,  according  to  what  I  myself  have 
seen,  and  the  results  of  my  reading,  the  principal  condi- 
tions which  a  syphilitic  subject  ought  to  satisfy  in  order 
to  have  the  moral  right  to  aspire  to  marriage  (that  which 
I  will  term,  by  abbreviation,  conditions  oftlie  admissibility 
to  marriage  of  a  syphilitic  subject)  may  be  summaiized  in 
the  following  programme : 

1.  Absence  of  EXisTmo  specific  accidents. 

2.  Advanced  age  of  the  diathesis. 

*  It  would  be  a  serious  injustice,  nevertheless,  not  to  mention  here  -with  praise 
the  names  of  two  contemporaneous  physicians  who  have  specially  treated  some  of  the 
questions  bearing  upon  our  present  study,  viz.,  M.  Edmond  Langlebert,  author  of 
an  interesting  work,  very  admirably  written,  upon  La  sypldlis  dans  aes  relations 
avec  le  mariage  (Paris,  18Y-3).  The  reader  will  there  find  several  chapters  exhaust- 
ively studied,  and  stamped  with  great  clinical  judgment.  Unfortunately,  it  is  to  be 
regretted  that  the  author  should  have  allowed  himself  to  be  diverted  from  his  prin- 
cipal subject  by  devoting  a  considerable  portion  of  his  book  to  foreign  questions. 
And  also  M.  Diday,  who,  in  several  of  his  publications,  notably  in  his  TJierapeutique 
des  affections  veneriennes  (Paris,  IS'ze),  has  treated  the  same  subject  with  that 
sparkling  verve,  that  vivacity,  that  humor,  which  every  one  recognizes  as  his. 


CONDITIONS  OF  ADMISSIBILITY  TO  MARRIAGE.      79 

3.  a  ceetain  period  of  absolute  immunity  con- 
secutive to  the  last  specific  manifestations. 

4.  non-theeatening  chaeactee  of  the  disease. 

5.  Sufficient  specific  treatment. 

Sucli  is,  at  least  according  to  tlie  results  of  my  experi- 
ence, the  enseuible  of  conditions  medically  to  be  required 
of  every  sypMlitic  patient  in  order  that  the  doors  of  mar- 
riage may  be  opened  to  him.  If  the  said  patient  satisfies 
all  these  combined  conditions,  I  consider  him  fit  to  become 
a  husband  and  father  without  danger. 

In  the  contrary  case,  I  do  not  consider  myself  author- 
ized to  grant  my  consent — the  moral  authorization  which 
he  comes  to  ask  of  me.  I  dissuade  him  from  marriage  ;  I 
forbid  his  marriage  with  all  my  power.  But  let  us  enter 
into  details.  Let  us  explain,  comment  upon,  and  Justify 
this  programme,  which  I  am  very  far  from  presenting  to 
you  as  definitive,  as  not  susceptible  of  modifications,  and 
of  further  amendments,  but  which  seems  to  me  at  least  to 
contain  the  principal  conditions  to  which  it  is  necessary 
to  restrict  every  syphilitic  subject  aspiring  to  marriage. 

First  condition :  Absence  of  existing  specific  acci- 
dents. 

This  first  point  certainly  will  not  arouse  dispute.  It  is 
elementary,  in  fact,  for  all  the  world — for  the  i^eople  as 
well  as  for  physicians — that  the  first  obligation  for  a  syph- 
ilitic candidate  for  marriage  to  fulfill  is.  that  he  present 
no  syphilitic  accidents  at  the  very  time  of  his  marriage. 
For  the  existence  of  the  least  syphilitic  accident  is  a  flam- 
ing evidence  of  the  disease,  of  the  disease  not  only  poten- 
tial but  actual.  And  it  matters  little,  moreover,  whether 
this  accident  be  of  a  transmissible  nature  or  not,  for — 1.  If 
it  be  of  a  transmissible  nature,  the  contraindication  of 
marriage  is  as  express  and  absolute  as  possible ;  2.  If  it 


80  SYPHILIS  AND  MARRIAGE. 

be  not  of  a  contagious  nature,  it  none  the  less  reveals  a 
permanent  diathesis,  with  all  its  dangers  and  consequences. 
But  we  need  not  insist  upon  this,  for  the  evidence  is  too 
direct.  And  one  might  be  astonished  that  a  proposition 
like  this,  the  absence  of  accidents  at  the  epoch  of  marriage, 
should  even  need  to  be  enunciated.  A  priori,  in  fact,  one 
would  scarcely  believe  that  men  could  be  found  so  desti- 
tute of  moral  sense,  so  ignoble,  so  shameless  as  to  dare 
become  husbands  with  the  existing  accidents  of  the  pox. 

And,  nevertheless,  do  not  deceive  yourselves,  gentle- 
men, this  incredible  audacity  is  sometimes  encountered. 
You  will  find  certain  cases  already  signalized  in  medical 
literature.  For  my  part,  I  have  witnessed  such  cases  a 
dozen  times.  I  have  seen  (and  I  hold  up  the  fact  to  public 
indignation)  people  marry  while  presenting  the  i^ery  day 
of  their  nuptials  such  or  such  syphilitic  symptoms,  as 
cutaneous  syphilides  (palmar  psoriasis,  papulo- squamous 
syphiMe,  ecthyma  of  the  legs),  mucous  patches  of  the 
mouth  or  throat,  genital  mucous  patches,  specific  sarco- 
cele,  accidents  premonitory  of  cerebral  syphilis.*  I  have 
in  my  notes  the  histories  of  two  individuals,  who,  in  spite 

*  The  last  case  to  which  I  make  allusion  is  truly  so  extraordinary  in  all  respects 
as  to  merit  special  mention.  A  young  man,  syphilitic  for  several  years,  allowed 
himself  to  be  engaged  in  marriage  despite  various  cerebral  phenomena,  the  nature 
of  whicb,  moreover,  he  but  imperfectly  comprehended  (heaviness  of  the  head,  pass- 
ing vertigo,  little  aptitude  for  work,  change  of  character,  and,  especially,  defects  of 
memory).  The  day  of  the  wedding  arrived,  but  the  bridegroom  did  not  appear 
at  the  ceremony.  He  was  sought  after,  and  was  found  occupied  with  nothing  but 
Bitting  at  the  comer  of  his  hearth,  reading  a  paper,  having  totally  forgotten  that  he 
was  to  be  married  that  day.  Nevertheless,  the  affair  was  proceeded  with,  and  (it 
can  scarcely  be  believed)  the  marriage  took  place.  The  cerebral  trouble,  be  it 
well  understood,  became  aggravated  after  this.  Some  months  later,  a  separation 
of  the  married  couple  had  to  be  pronounced,  because  of  the  abuse,  cruelties,  and 
violences  of  the  husband  toward  his  wife.  Then  the  patient  had  an  attack  of 
mania,  presented  various  accidents  more  and  more  intense  of  specific  encepha- 
lopathy, and  finally  fell  into  dementia.  An  English  physician  of  my  acquaintance 
has  informed  me  that  he  had  observed  a  case  almost  identical  with  the  preceding. 


CONDITIONS  OF  ADMISSIBILITY  TO  MARRIAGE.      81 

of  my  most  energetic  protestations,  were  married  when 
they  each  had  on  the  penis  an  indurated  chancre  in  the 
stage  of  full  development.  That  is  not  to  be  believed,  is 
it  ?  But  it  is  true,  I  assure  you,  I  give  you  my  word,  and 
it  proves  once  more  that  "the  truth  is  not  probable." 

What  motives,  what  morbid  incitements  thus  impel 
certain  persons  to  marry  under  such  conditions,  in  spite 
of  actual  syphilitic  symptoms  ?  This  is  a  question,  a  sub- 
ject of  study,  which  concerns  the  philosopher,  the  moral- 
ist, rather  than  the  physician.  It  is  not,  however,  a  matter 
of  indifference  to  us,  for  we  often  need,  in  the  exercise  of 
our  vocation,  to  understand  the  moral  as  well  as  the  phys- 
ical pathology  of  our  patients.  Allow  me,  then,  to  say  a 
few  words  in  regard  to  it. 

]^ow,  according  to  my  observation,  the  motives  that  in- 
fluence certain  persons  to  a  course  of  action  so  unjustifi- 
able are  not  ordinarily  those  which  one  would  be  inclined 
a  priori  to  suppose,  viz.,  ignorance  or  interest.  Without 
doubt,  there  are  persons  who  marry  in  an  active  stage  of 
the  pox  from  an  absolute  ignorance  of  the  dangers  to 
which  they  expose  their  wives,  their  future  children,  and 
themselves.  They  do  not  know  what  they  have,  they 
make  no  account  of  it ;  they  have  not,  from  thoughtless- 
ness or  stupidity,  even  dreamed  of  consulting  a  physician. 
These  are  the  simple,  the  indifferent,  the  imbecile. 

Without  doubt,  there  are  others  who  understand  per- 
fectly both  what  they  have  and  what  they  may  transmit ; 
who  take  an  exact  account  of  the  situation,  and,  while 
appreciating  all  its  dangers,  nevertheless  brave  these 
dangers,  because  they  have  a  superlative  interest  in  brav- 
ing them,  viz.,  a  dowry  to  secure,  a  situation  to  make,  a 
"position"  to  gain.  They  are  the  audacious  and  the 
infamous. 


82  SYPHILIS  AND  MARRIAGE. 

But  most  often  this  is  not  the  case.  In  general  (at  least 
according  to  the  result  of  my  personal  observation)  the  in- 
dividuals who  are  led  on  to  this  revolting  act  of  marriage, 
while  the  pox  is  in  full  activity,  are  frivolous  and  of  feeble 
character,  who  foolishly,  thoughtlessly,  become  engaged 
to  be  married  when  they  are  as  unfit  for  it  as  possible  ; 
then,  when  the  fatal  moment  arrives,  they  find  themselves 
driven  into  a  corner  from  which  they  dare  not  escape. 
Although  very  much  ashamed  of  the  act  which  they  are 
about  to  commit,  w^hile  regretting  it,  deploring  it  even  in 
their  inmost  conscience,  they  have  not  the  courage  to  re- 
cede, to  withdraw,  for  fear  of  a  scandal,  of  the  publicity 
of  a  rupture  without  avowable  motives,  for  fear  of  what 
peojole  may  say,  of  public  malice  coming  to  suspect  their 
disease^  In  brief,  to  save  apjoearances  they  commit  no- 
thing less  than  the  worst  cowardice. 

Are  these  last  less  culpable  than  the  former  ?  At  any 
rate,  they  only  arrive  at  the  same  result  in  other  ways.f 

*  Example :  Some  years  ago  a  young  man  from  the  country  came  to  ask  my 
advice  for  certain  existing  accidents  of  secondary  syphilis  (buccal  syphilides,  alo- 
pecia, crusts  of  the  hairy  scalp,  etc.).  The  consultation  completed,  he  added,  with  a 
confused  air,  that  he  was  engaged  in  matrimonial  projects,  and  finished  by  avow- 
ing that  he  was  even  contemplating  a  quite  early  marriage.  I  hastened  immediately 
to  declare  to  him  that  it  was  absolutely  impossible  for  him  to  carry  out  such  projects 
in  the  condition  in  which  he  was,  and  I  gave  him  the  reasons  :  I  insisted  energetically, 
seeing  him  little  inclined  to  allow  himself  to  be  convinced,  and  I  unfolded  to  him 
the  entire  series  of  dangers  to  which  he  was  about  to  expose  himself  and  his  future 
family.  Now,  to  all  my  arguments  this  young  man  opposed  an  obstinate  response, 
always  the  same,  viz.,  that  "  he  is  constrained  to  marry  for  fear  that  his  disease 
might  be  suspected."  "  I  should  like  to  follow  your  counsels,  doctor,  but  this  is 
not  possible  under  the  circumstances.  What  motive  can  I  assign  for  a  rupture 
that  shall  satisfy  the  two  families  ?  What  would  they  say  of  me  in  my  little  vil- 
lage in  the  country  ?  They  will  suspect  or  succeed  in  finding  out  the  true  motive 
of  my  withdrawal,  and  then  I  shall  be  ruined,  disgraced,"  etc.  And  some  months 
later  I  heard,  indirectly,  the  news  of  his  marriage. 

f  If  I  did  not  fear  to  exceed  the  limits  of  my  programme,  I  would  annex  to  this 
chapter  some  considerations  relative  to  those  subjects  who  marry  during  the  actual 
period  of  the  incuhaiion  of  syphilis.     Cases  of  this  kind  are,  of  course,  very  rare, 


CONDITIONS  OF  ADMISSIBILITY  TO  MARRIAGE.      83 

Second  condition:  Advanced  age  of  the  diathe- 
sis. 

With  this  second  point  we  touch,  upon  one  of  the  most 
important  and  essential  conditions  of  our  programme. 
In  a  general  manner,  indeed,  it  may  be  stated  as  an  ax- 
iom :  The  more  recent  the  sypliilis  of  the  husband,  the 
more  numerous,  the  more  serious  will  he  the  dangers 
vjhich  he  introduces  into  marriage.  "Whence  this  corol- 
lary :  The  older  our  patient' s  syphilis,  the  more  shall  we 
be  authorized  (save  for  special  indications  of  another  kind) 
to  toler^^te  his  marriage. 

Let  us  Justify  the  preceding  proposition.  In  the  first 
place,  let  us  examine  the  question  from  the  point  of  view 
of  the  dangers  of  infection  for  the  wife. 

Without  possible  contradiction,  it  may  be  asserted  that 
a  young  syphilis  is  especially  dangerous,  in  so  far  as  con- 

but  nevertheless  worthy  of  attention.  They  may  be  thus  summarized :  A  healthy 
man,  some  days  before  his  marriage  (a  fortnight,  for  example),  has  connection 
with  a  woman  infected  with  syphilis,  and  receives  the  contagion  from  her.  As  the 
first  symptoms  of  the  disease  are  always  separated  from  the  date  when  contagion 
was  effected  by  a  period  of  three  weeks,  on  an  average,  sometimes  a  month,  and 
even  more,  this  man  marries  with  the  appearance  of  perfect  immunity.  It  is  not 
until  from  eight  to  ten  or  fifteen  days  afterward  that  the  initial  phenomena  of  in- 
fection begin  to  reveal  themselves,  und6r  the  foi'm  of  one  or  more  local  erosions. 
So  that  the  syphilis  contracted  before  marriage  does  not  reveal  itself  until  after  mar- 
riage, thanks  to  the  prolonged  incubation  which  always  preludes  its  outbreak. 
Now,  what  happens  in  these  conditions  ?  It  is  that  the  husband,  not  initiated  into 
the  secrets  of  syphilitic  incubation,  and  believing  himself  exempt  from  all  possi- 
bility of  contagion,  scarcely  pays  any  attention  to  the  lesion  which  has  just  com- 
menced to  appear  upon  him.  He  is  far  from  supposing  that  this  lesion  may  be  of 
a  contagious  nature ;  he  mistakes  it  for  an  "  abrasion,  a  scratch,  an  insignificant 
trifle."  Consequently,  he  does  not  abstain  from  intercourse  with  his  young  wife, 
and  in  this  way  he  transmits  the  syphilis  to  her.  I  have  already  observed  four 
cases  of  this  kind ;  and  in  these  four  cases  the  contagion  was  invariably  trans- 
mitted to  the  young  vi'ife.  As  an  example,  I  will  hereafter  relate  the  history  of 
one  of  these  cases  (vide  "  Notes  and  Illustrative  Cases,"  Note  IV).  The  possibility  of 
a  contamination  of  this  kind  in  marriage  is  scarcely  known,  and  it  would  seem  to 
have  but  little  engaged  the  attention  of  clinicians.  For  the  interests  of  all,  it  is 
desirable  that  it  should  become  of  more  general  notoriety. 


84-  SYPHILIS  AND  MARRIAGE. 

tagiousness  is  concerned.  In  fact — 1.  It  is  a  common  no^ 
tion  that  the  disseminated,  scattered  manifestations  of  the 
diathesis,  which,  under  the  name  of  mucous  patches,  or, 
better,  of  erosive,  papulo-erosive,  papulo-ulcerative  syphi- 
lides,  etc.,  so  frequently  affect  the  various  mucous  surfaces 
and  the  skin— it  is  a  common  notion,  I  say,  that  these  le- 
sions especially  belong,  chronologically,  to  the  earlier  stage 
of  the  disease,  to  what  is  termed  the  secondary  period.  It 
is  in  the  first  months,  in  the  first  two  or  three  years  of  the 
infection,  that  they  are  observed  almost  exclusively.  Now, 
the  contagiousness  of  such  accidents  needs  no  deijionstra- 
tion  to-day.  We  can  even  say  that  accidents  of  this  or- 
der constitute  the  principal  source  which  feeds  and  prop- 
agates the  pox  among  us.  2.  Every  one  knows,  in  the 
second  place,  that,  in  the  first  two  or  three  years  of  the 
diathesis,  the  morbid  manifestations  of  which  we  have  Just 
spoken  are  more  particularly  apt  to  multiply,  to  recur, 
and  that  with  a  persistence  sometimes  desperate.  Let 
us  cite,  for  example,  the  buccal  mucous  patches  which, 
among  smokers  more  particularly,  are  produced  and  re- 
produced vdth  many  repetitions  in  the  course  of  the  first 
months  or  the  first  years  of  the  disease.  3.  In  addition, 
at  this  same  period  of  the  diathesis,  there  are  two  centers 
of  predilection  which  influence  the  morbid  determinations, 
viz.,  the  mouth  and  the  genital  organs. 

Now,  it  is  precisely  these  two  localities  which  are  the 
most  dangerous  from  the  point  of  view  which  now  occu- 
pies us,  for  it  is  from  these  centers  that  the  contagion  vdll 
naturally  have  the  most  numerous  chances  to  transmit 
itself  in  marriage. 

Let  us  add  still  another  consideration:  secondary 
syphilis  is  particularly  dangerous,  as  regards  contagion, 
from  the  henignity^  even,  of  its  accidents.    Very  often  the 


CONDITIONS  OF  ADMISSIBILITY  TO  MARRIAGE.      85 

lesions  wMch  it  determines  upon  the  mucous  membranes, 
in  the  mouth  or  on  the  penis,  notably,  consist  only  in  very 
superficial  erosions,  slight  in  extent,  almost  simply  des- 
quamative. Now,  such  lesions  may  easily  pass  unper- 
ceived,  even  by  careful  persons,  attentive  to  their  health. 
They  are  also  apt  to  be  confounded  with  common,  or^ 
dinary,  insignificant  erosions.  On  the  penis,  for  example, 
they  are  frequently  taken  for  simple  excoriations,  for  her- 
petic or  other  inflammatory  abrasions.  In  the  mouth,  they 
pass  not  less  commonly  for  aphthae,  fissures,  etc.,  ,"  local 
irritations  from  the  cigar  or  cigarette,"  etc.  Altogether, 
for  one  reason  or  another,  one  does  not  mistrust  tJiem, 
so  inoffensive  are  they  in  appearance.  And  this,  indeed, 
constitutes  the  danger,  for  such  slight,  benign  accidents 
do  not  seem  to  necessitate  continence,  and  they  thus  be- 
come the  origin  of  frequent  contagion  in  marriage.  This 
is  a  point  which  I  restrict  myself  to  simply  indicating  for 
the  moment ;  hereafter  I  shall  have  occasion  to  return  to 
it  in  detail. 

Such,  gentlemen,  are  various  reasons  on  account  of 
which  a  young  syphilis  is  so  formidable  from  the  point  of 
view  of  contagion.  Quite  the  contrary,  at  a  more  re- 
mote period,  and  a  fortiori,  in  an  advanced  stage  of  the 
diathesis,  these  same  dangers  of  contagion  no  longer  ex- 
ist, or,  at  least,  only  present  themselves  in  a  manner  much 
more  restricted,  relatively,  and  much  less  common.  And 
this  is  on  account  of  reasons  exactly  the  opposite,  viz.  :  be- 
cause an  old  syphilis  reveals  itself  only  by  manifestations 
infinitely  less  multiple,  more  discrete,  less  subject  to  re- 
currence, etc. ;  because  it  no  longer  affects  with  the  same 
predilection  those  two  centers  so  favorable  to  contagion, 
the  mouth  and  the  penis ;  because  the  lesions  which  it 

determines  in  this  period  consist  no  longer  in  minute, 

7 


86  SYPHILIS  AND  MARRIAGE. 

superficial  erosions,  susceptible  either  of  passing  unper- 
ceived,  or  of  being  confounded  with  inoffensive  accidents 
of  a  common  order,  but  in  large,  profound,  important, 
persistent  ulcerations  whicli  could  neither  escape  the  at- 
tention of  the  patient,  nor  permit  the  possibility  of  conta- 
gion through  indifference,  inadvertence,  etc. 

And  do  not,  gentlemen,  regard  what  precedes  as  pure 
theory,  but,  on  the  contrary,  as  conclusions  deduced  from 
experience.  In  addition,  consult  the  results  of  the  clinic, 
and  search  at  what  period  of  the  diathesis  contagion  is 
principally  produced.  Observe,  especially,  who  are  the 
husbands  that  communicate  syphilis  to  their  wives.  I 
have  made  this  investigation  for  my  part,  I  have  just 
examined  my  notes  on  this  subject,  and  without  qualifi- 
cation I  have  arrived  at  this : 

If  not  always,  at  least  in  an  enoimous  majority  of 
cases,  the  husbands  that  communicate  syphilis  to  their 
wives  are  those  who  have  entered  into  marriage  with  a 
sypMlis  still  young — that  is  to  say,  with  a  syphihs  dat- 
ing back  several  months,  one  year,  two  years,  more  rarely 
three  or  four  years. 

When  a  man  marries  with  a  recent  syphilis  still  active, 
the  infection  of  the  wife  is  an  almost  constant  occurrence. 
On  the  contrary,  much  more  rare  are  the  cases  where  the 
infection  of  the  wife  is  produced  when  the  husband's 
syphilis  is  more  or  less  old — that  is  to  say,  dates  back  six, 
eight,  ten  years  or  more.  Upon  these  two  points,  I  re- 
peat it,  my  observations  are  precise — as  positive  and  con- 
vincing as  possible.  And  I  recapitulate  by  saying :  BypM- 
litic  contagion  in  marriage  is  much  the  more  to  he  feared 
for  the  wife  the  more  recent  the  date  of  the  syphilis  of  the 
liustand. 

II.  Likewise,  from  the  point  of  view  of  hereditary  in- 


CONDITIONS  OF  ADMISSIBILITY  TO  MARHIAGB.      87 

fluence,  an  advanced  age  of  the  paternal  syphilis  is  a  con- 
dition equally  favorable. 

It  is  a  fact  remarked  of  ancient  date,  recorded  in  a 
positive  manner  by  various  authors,  that  the  syphilitic  in- 
fluence of  the  father  upon  his  children  undergoes  a  pro- 
gressive decrease  in  proportion  as  the  diathesis  becomes 
old.  Thus,  for  my  part,  in  those  cases  where  I  have  ob- 
served the  syphilis  pass  directly  from  the  father  to  the 
child  without  contamination  of  the  mother,  I  have  re- 
marked that  the  paternal  affection  was  always  of  recent 
date — that  is  to  say,  it  has  never  exceeded,  at  the  maxi- 
mum, three  or  four  years.  Beyond  this  term,  I  have 
never  clearly  made  out  the  transmission  of  syphilis  by 
paternal  heredity. 

Another  proof  still  is  furnished  to  us  by  those  cases  of 
successive  abortions  which  I  have  already  referred  to  as 
the  possible  consequences  of  the  syphilis  of  the  husband. 
More  than  once  this  has  been  observed  ;  a  healthy  woman, 
exempt  from  syphilis,  begins  by  having  several  miscar- 
riages ;  then  (the  first  improvement  being  realized  under 
the  sole  influence  of  time,  the  husband  still  continuing  to 
neglect  treatment)  this  same  woman  does  not  abort  any 
more,  she  only  is  confined  he/ore  term,  and  always  of  a 
dead  infant ;  then,  second  stage  of  improvement  (since  we 
are  compelled  to  characterize  this  by  the  term  improve- 
ment), she  is  delivered  at  term  of  an  infant  dead  or  des- 
tined to  a  speedy  death ;  still  later,  at  length  she  brings 
forth  one  or  more  living  infants. 

What  could  more  thoroughly  demonstrate  the  normal 
decrease  of  the  hereditary  syphilitic  infiuence  under  the 
sole  action  of  time  f  A  propos  of  this,  allow  me  to  cite  a 
curious  case  related  by  one  of  our  English  confreres,  well 
known  among  us,  Mr.  Hutchinson : 


88  SYPHILIS  AND  MARRIAGE. 

A  physician  contracts  syphilis  and  treats  himself  for 
about  six  months.  Believing  himself  cured,  and  free  from 
all  api^rehension,  he  marries  three  or  four  years  later. 
His  wife  remains  Tiealtliy  and  becomes  enceinte  eleven 
times.  Now,  gentlemen,  look  at  the  results  furnished  by 
these  different  pregnancies,  and  mark  the  progressive  at- 
tenuation which  the  diathesis  undergoes  under  the  sole 
influence  of  time : 

First  pregnancy  :  child  still-horn. 

Second  pregnancy  :  child  still-horn. 

Third  pregnancy  :  child  bom  alwe^  but  sypMUtic  and 
dying,  with  the  characteristic  symptoms  of  hereditary 
syphilis. 

Fourth  pregnancy :  child  born  alive,  but  sypMlitic 
and  dying,  likewise  from  syphilis. 

On  the  contrary,  the  last  seven  pregnancies  furnish 
children  who,  although  syphilitic,  resist  the  disease  and 
all  remain  living.*  And,  moreover,  could  one  call  in 
doubt  the  attenuating  and  corrective  influence  of  time 
upon  paternal  heredity  when  this  same  influence  shows 
itself  in  so  positive  and  evident  a  manner  upon  ma- 
ternal heredity,  or,  collectively,  upon  mixed  heredity 
derived  from  the  two  parents?  Is  not  this  a  fact  ab- 
solutely demonstrated,  is  not  this  a  veritable  pathologi- 
cal law,  the  gradual  diminution,  then  the  final  extinc- 
tion of  the  syphilitic  reaction  of  the  parents  upon  the 
children?  Examples  quite  convincing  in  this  respect 
have  been  given  by  different  authors — by  Bertin,t    by 

*  Memoir  cited,  "Brit,  and  For.  Med.-Chirurg.  Review,"  1877,  vol.  Ix. 
•)•  Here  is  the  summary  of  the  curious  case  of  Bertin,  to  which  allusion  is  made : 
Father  and  mother  sj-philitic.     First  pregnancy :   abortion  at  six  months ;  in- 
fant still-born.     Second  pregnancy :  abortion  at  seven  months  ;  infant  living  eight 
hours.     Third  pregnancy :  accouchement  at  seven  and  a  half  months,  of  a  dead 
infant.     Fourth   pregnancy :    accouchement  at  term ;    child  syphilitic,  surviving 


CONDITIONS  OF  ADMISSIBILITY  TO  MARRIAGE.      89 

M.  Diday,*  by  M.  Bazin,  f  by  M.  Roger,  %  by  M.  Kas- 
sowitz,  §  and  many  others.  But  none  is  more  cogent  and 
better  calculated  to  carry  conviction  tlian  a  very  curious 
case  of  M.  Mireur,  summarized  thus : 

A  young  mason  contracts  an  indurated  chancre,  and 
marries  at  the  very  dehut  of  the  secondary  stage.  He 
does  not  fail,  for  he  can  not,  to  infect  his  young  wife  im- 
mediately. 

After  this  there  occur  eight  pregnancies,  the  results 
of  which  are  unfolded  according  to  the  characteristic  ten- 
dency of  the  disease,  the  liusband  and  wife  remaining 
exempt  from  all  treatment. 

ISTow,  these  eight  pregnancies  terminate  in  the  follow- 
ing manner : 

First  pregnancy :  abortion  at  fifth  month. 

Second  pregnancy,  abortion  at  seventh  month. 

Third  pregnancy :  accouchement  before  term ;  cliild 
dead. 

eighteen  days.  Fifth  pregnancy :  accouchement  at  term ;  child  syphilitic,  sur- 
viving six  weeks.  Sixth  pregnancy :  accouchement  at  term ;  child  syphiHtic,  but 
surviving. — Traite  de  la  nialadie  venerienne  chez  les  nouveau-nes,  Paris,  1870,  p.  142. 

*  Traite  de  la  syphilis  des  nouveau-nes  et  des  enfants  d  la  mamelle,  Paris,  1854, 
p.  183. 

f  Legons  theoretiques  et  cliniques  sur  la  syphilis  et  les  sypJiilides,  Paris,  1866,  p. 
164. 

I  Summary  of  an  observation  related  by  M.  Roger  :  Father  and  mother  syphi- 
litic. First  pregnancy :  accouchement  at  eight  and  a  half  months  ;  infant  dead. 
Second  pregnancy :  accouchement  at  term ;  infant  dead.  Third  pregnancy :  Ac- 
couchement at  term ;  child  living  but  syphilitic,  covered  with  lumps  when  one 
month  old,  and  dying  at  four  months.  Fourth  pregnancy  :  accouchement  at  term; 
child  living,  strong  and  well  nourished.  From  the  second  to  the  third  month  this 
child  was  affected  with  a  syphilide  limited  to  the  buttocks,  afterward  with  a  very 
intense  coryza  ;  died  at  eight  months.  Fifth  pregnancy :  accouchement  at  term ; 
"  child  syphilitic,  hke  the  others,  but  in  a  less  degree  of  severity  (roseola  simplex). 
Treated  by  mercurial  medication,  it  was  completely  cured.  It  is  now  seventeen 
months  old  and  perfectly  well." — ^tude  clinique  sur  la  syphilis  infantile  (Union 
Medicale,  1865,  t.  i,  p.  147). 

§  Die  Vei-ei-hung  der  Syphilis,  Vienne,  18*76. 


90  STPHILIS  AND  MARRIAGE. 

Fourtli  and  fifth  pregnancies :  Children  living,  but 
both  sypTiilitic — the  first  dying  at  thirty  days,  the  second 
at  one  month  and  a  half. 

Sixth,  seventh,  and  eighth  pregnancies :  children  living 
and  healthy.* 

Such  a  fact  is  sufficiently  eloquent  of  itself  to  ren- 
der all  comment  unnecessary.  Now,  if  it  be  thus  for 
mixed  heredity,  one  can  scarcely  comprehend  that  it 
could  be  otherwise  for  paternal  heredity  alone. 

Then,  time  exhausts  the  paternal  syphilitic  influence 
and  renders  it  less  and  less  dangerous  for  the  offspring  ; 
here  is  a  point  which  appears  to  be  well  demonstrated. 

From  this  there  follows  the  practical  conclusion  that 
with  syphilis  all  the  chances  are  in  loaiting  the  longest 
possible  time  before  aspiring  to  the  role  of  father  of  a 
family.  This,  at  least,  seems  to  me  to  result  in  a  manner 
as  direct  as  possible  from  the  facts  observed  by  me  up  to 
this  time. 

III.  From  the  point  of  view  of  the  personal  risk  which 
a  syphilitic  subject  carries  with  him  into  marriage,  an  ad- 
vanced age  of  the  diathesis  is  again  a  condition  certainly 
favorable,  and  constitutes  an  additional  guarantee  —  a 
guarantee  not  positive  and  absolute,  be  it  well  understood, 
but  at  least  relative. 

And,  in  reality,  the  advanced  age  of  the  diathesis  per- 
mits us,  in  a  certain  measure,  to  better  appreciate  the 
"quality"  of  this  diathesis,  its  degree  of  intensity,  its 
general  prognosis.  Not,  assuredly,  that  in  the  case  of 
syphilis  the  past  is  always,  as  it  has  been  termed,  "the 


*  Thesis  cited,  p.  91.  A  curious  point  is  that  consecutively  to  the  last  three 
pregnancies,  which  resulted  in  living  and  healthy  children,  the  father  and  mother 
Btill  presented  various  syphihtic  accidents  of  a  grave  form,  such  as  "  gummoua 
and  ulcerated  tubercles,  abundantly  diffused  over  the  limbs." 


CONDITIOFS   OF  ADMISSIBILITY  TO  MARRIAGE.      91 

mirror  of  the  future";  far  from  it.  Not  tliat  a  syphilis 
primarily  benign  may  not  result  in  serious  or  mortal 
accidents  at  a  remote  period.  But  it  is  always  the  case 
that,  at  a  period  more  or  less  advanced,  certain  accidents, 
certain  menacing,  malignant  forms  of  the  disease,  are  no 
longer  to  be  feared.  Moreover — and  this  is  the  essential 
point  —  the  stage  comprised  between  the  debut  of  the 
disease  and  the  present  time  may  have  been  employed 
advantageously  in  a  long  and  salutary  treatment,  which 
confers  the  best  and  most  substantial  of  guarantees  in  all 
such  cases. 

Hence,  in  every  respect,  you  see,  the  long  standing  of 
the  disease  constitutes  an  essential,  an  indispensable  con- 
dition of  admissibility  to  marriage. 

In  my  opinion,  a  syphilitic  subject  has  neither  the 
privilege  nor  the  right  to  aspire  to  marriage  unless  his 
disease  dates  back  a  certain  time,  unless  it  has  already 
behind  it  a  certain  duration.  This  I  positively  affirm,  and 
lay  down  as  a  principle,  it  being  my  absolute  conviction, 
now  based  upon  a  very  large  number  of  observations. 

Now,  you  will  very  properly  press  me  further,  and,  de- 
manding of  me  more  precise  indications,  will  say:  "Be 
it  so ;  a  certain  duration  of  the  disease  is  indispensable 
for  admissibility  to  marriage.  But  speak  more  definitely  ; 
state  in  precise  figures  what  is,  what  in  your  opinion 
ought  to  be,  this  duration?"  Ah!  here  comes  the  deli- 
cate point.  As  long  as  we  have  to  deal  with  general  terms 
solutions  are  easy.  But  when  it  becomes  necessary  to  fix 
an  arithmetical  measure,  when  we  come  to  figures,  the 
difficulties  begin.  Nevertheless,  the  same  facts  which, 
have  served  me  in  stating  the  general  rules  which  precede 
will  permit  me,  within  a  certain  limit,  to  satisfy  you,  and 
I  shall  reply  as  follows  : 


92  .  SYPHILIS  AND  MARRIAGE. 

In  the  first  place,  the  age  of  a  syphilis  is  not  the  sole 
fact  from  which  one  may  determine  the  admissibility  or 
non-admissibihty  to  marriage.  This  decision  embraces 
other  factors,  involves  other  important  and  paramount 
conditions,  of  which  we  shall  siDeak  shortly,  such  as  the 
nature  of  the  anterior  specific  accidents,  the  "quality"  of 
the  diathesis  (you  will  see  what  I  mean  by  this  word),  the 
intervention  of  a  sufficient  treatment,  the  influence  exer- 
cised by  such  treatment,  etc.  So  that  the  age  alone  of  the 
disease  can  never  be  taken  as  a  basis  to  solve  the  problem 
before  us,  namely,  to  decide  whether  a  syphilitic  subject 
has  or  has  not  become  fit  for  marriage. 

With  these  reservations,  I  shall  enter  uj)on  the  question 
to  which  you  await  a  resjoonse,  and  at  once  give  you  my 
profession  of  faith,  which  may  thus  be  summarized  : 

To  regard  for  the  moment  only  the  fact  of  the  age,  I  do 
not  think  that  a  syphilitic  subject  should  be  permitted  to 
think  of  marriage  until  after  a  minimum  period  of  three 
or  four  years  devoted  to  a  most  careful  treatment. 

Three  or  four  years  is,  in  my  opinion,  the  minimum 
(note  well  the  word,  I  beg  of  you),  the  necessary  indis- 
pensable minimum,  in  order  that  the  diathesis  may  be  suf- 
ficiently weakened  under  the  double  influence  of  time  and 
treatment ;  in  order  that  the  patient,  restored  to  ordinary 
conditions,  may  properly  aspire  to  become  husband,  fa- 
ther, head  of  a  family. 

Yes,  three  or  four  years  ;  for  it  is  not  too  much.  My 
requirements  are  not  excessive.  A  longer  time  would  he 
better,  I  am  quite  certain.  For,  with  syphilis,  it  is  al- 
Avays  advantageous  to  wait,  to  defer,  when  there  are  such 
interests  at  stake  as  those  of  a  young  wife  and  an  entire 
family.  So  that  I  affirm  anew  the  proposition  which  I 
have  just  formulated,  and  which  is  the  result  of  experi- 


CONDITIONS  OF  ADMISSIBILITY  TO  MARRIAGE.      93 

ence  :  Short  of  the  minimum  above  cited,  there  is  every- 
thing to  fear,  and  the  dangers  of  syphilis  in  the  hus- 
band are  revealed  by  catastrophes  which,  if  not  inevitable 
and  constant,  are  at  least  frequent  and  habitual.  Beyond 
that  term,  the  dangers  from  the  syphilis  of  the  husband 
decrease  and  disappear,  if  not  in  a  manner  absolutely 
certain  (for  mathematical  certainty  is  and  ever  will  be 
unattainable  in  such  matters),  at  least  very  frequently,  so 
frequently,  at  any  rate,  as  to  warrant  us  in  allowing  mar- 
riage. Still  it  is  necessary,  be  it  understood  (and  here  is 
a  point  upon  which  I  do  not  hesitate  to  insist  again),  that, 
during  the  period  in  question,  the  curative  influence  of 
a  systematic,  methodic,  active,  and  prolonged  treatment 
shall  be  added  to  the  corrective  influence  of  time. 

Before  three  or  four  years  are  past,  I  could  never  dare, 
for  my  part,  whatever  may  have  been  the  activity  of  the 
treatment,  to  grant  a  clear  license  of  marriage  to  a  syphi- 
litic subject.  For  I  have  seen  the  saddest,  the  most  un- 
fortunate consequences  succeed  premature  unions  of  this 
kind.  After  three  or  four  years  usefully  devoted  to  a 
depurative  medication,  I  believe  that  I  am  authorized  by 
experience  to  tolerate  marriage,  unless  there  be  some  par- 
ticular contraindication  noticed  in  some  other  portion  of 
my  programme.  And  this  because  I  have  seen  numbers 
of  syphilitic  subjects  marry  in  these  conditions  without 
becoming  noxious  to  their  wives  or  their  children. 

By  design,  I  have  Just  said  that  in  the  conditions  cited 
I  considered  myself  right  in  tolerating  marriage.  And, 
in  fact,  I  tolerate  it  in  such  a  case  rather  than  counsel  it. 
I  tolerate  it  because  I  consider  the  term  of  three  or  four 
years  as  strictly  sufficient  to  protect  the  interests  which  I 
have  at  heart.  But  I  will  frankly  say  that  a  longer  delay 
would  be  much  more  satisfactory  to  me,  as  affording  more 


9 J:  SYPHILIS  AND  MARRIAGE. 

effective  guarantees.  In  tlie  case  of  a  patient  whose  syph- 
ilis (besides  having  been  well  treated)  dates  back  six, 
eight,  or  ten  years,  I  feel  much  more  at  ease  in  giving  him 
a  clean  bill  of  health ;  and  this,  I  repeat  again,  because, 
from  numerous  points  of  view,  the  security  increases  with 
the  age  of  the  diathesis. 

So,  iDractically,  my  rule  of  conduct  is  the  following: 
When  consulted  upon  the  propriety  of  marriage  by  a 
patient  whose  syphilis  (although  regularly  treated)  dates 
back  only  three  or  four  years,  I  always  begin  by  coun- 
seling him  to  wait,  to  defer  his  project  of  union,  and  I 
insist  anew  upon  treatment,  with  the  view  of  increasing 
and  perfecting  his  chances  of  security.  But,  if,  never- 
theless, the  patient  urges  serious  and  paramount  reasons 
for  an  immediate  marriage,  and  if,  in  addition,  he  satis- 
fies all  the  other  requirements  of  my  programme,  I  do 
not  think  that  I  have  the  right  to  thwart  his  projects.  I 
tolerate  his  marriage  under  these  circumstances.  I  grant 
him  the  medical  authorization  which  he  comes  to  claim 
of  me — not,  however,  without  adding  certain  advice,  cer- 
tain indispensable  recommendations,  of  which  I  shall 
speak  hereafter  at  the  close  of  this  exposition. 


CHAPTER  IX. 

PEOLOI^^GED   PERIOD   OF  IMMUNITY — NON-MENACING  CHAfi- 
ACTEE   OF  THE  DIATHESIS. 

Third  condition :  Stage  of  immunity  sufficiently  pro- 
longed after  the  last  specific  manifestations, 

A  third  condition  wMch  I  regard  as  indisi^ensable  in 
this  matter  is,  that  a  period  more  or  less  prolonged  be- 
tween the  last  manifestations  presented  by  the  disease  and 
the  date  fixed  for  marriage  should  elapse  without  specific 
accidents.  That  is  to  say,  before  a  patient  has  the  right 
to  think  of  marriage,  it  is  necessary  that  he  remain  ex- 
empt from  any  diathetic  manifestation  during  a  time  suf- 
ficiently prolonged,  and  that  this  lapse  of  time,  which  I 
designate  as  the  period  of  immunity,  pass  without  any 
specific  symptom,  without  any  outbreak  of  the  syphilis. 

Now,  this  period  of  immunity  constitutes  a  necessary, 
indispensable  guarantee  for  admissibility  to  marriage  for 
several  reasons :  In  the  first  place,  it  has  a  significance. 
It  proves  that  the  diathesis  has  passed  its  acute  stage,  I 
mean  that  especially  formidable  period  where  the  syphi- 
litic outbursts  succeed  each  other  at  short  intervals,  some- 
times without  remission,  and  which  are  no  less  dangerous 
from  their  number  than  from  the  contagious  quality  of 
their  manifestations.  In  the  second  place,  this  time,  more 
or  less  lengthened,  passed  without  accidents,  permits  us  to 


96  SYPHILIS  AND  MARRIAGE. 

judge  of  tlie  degree  of  amelioration  of  the  diathesis.  It 
is  an  evidence  of  the  non-activity,  of  the  actual  sedation 
of  the  diathesis.  Without  doubt,  it  is  possible  that  the 
absence  of  accidents  during  a  certain  j)eriod  may  be  only 
a  truce  granted  by  the  disease,  which,  after  a  certain  time, 
will  reassert  all  its  rights.  But  it  is  possible,  also,  in 
cases  where  treatment  has  been  vigorously  employed,  that 
it  may  be  the  commencement  of  a  definitive  peace.  Why 
should  it  begin,  if  it  be  not  actually  a  definitive  peace  ? 

At  all  events,  it  is  undeniable  that  a  prolonged  immu- 
nity constitutes  a  good  sign — a  sign  which  corresponds  to 
an  arrest  of  the  disease,  which  attests  its  decrease,  its 
decline,  at  least  provisionally.  And  if  this  favorable  con- 
dition be  strengthened  by  the  additional  guarantee  of  a 
sufficient  medication,  there  is  reason  to  hope  that  the  di- 
athesis has  definitively  imposed  silence  upon  all  further 
manifestations.    Security  is  then  acquired  for  marriage. 

So  true  is  all  this,  that  a  prudent  physician  will  never 
permit  a  syphilitic  subject,  who  has  recently  had  syphilitic 
manifestations,  to  marry.  For  my  part,  I  never  allow  one 
of  my  patients  to  marry  soon  after  any  specific  accident 
whatever,  no  matter  how  trifling  it  may  have  been.  And 
this  for  two  reasons  :  first,  because  the  occurrence  of  any 
syphilitic  accident  proves  not  only  that  the  diathesis  con- 
tinues to  exist,  but  that  it  exists  in  full  activity ;  and,  in 
the  second  place,  because,  in  such  cases,  it  is  impossible  to 
predict  what  may  follow.  Are  not  other  morbid  determi- 
nations about  to  arise  in  the  near  future,  or  is  a  calm  about 
to  ensue  ?  Time  alone  can  decide  this  question.  To  wait 
is,  then,  the  rigorous  rule  in  such  a  situation.  On  the  con- 
trary, if  a  patient  comes  to  me  saying,  "  It  now  is  two  years, 
four  years,  six  years,  ten  years  since  I  have  exx^erienced 
anything,"  this  long  silence  of  the  disease  puts  me  quite 


PROLONGED  PERIOD   OF  IMMUNITY.  97 

at  ease.  I  perceive  that  I  have  to  do  with,  a  diathesis  in 
process  of  sedation,  with  a  diathesis  which  has  passed  its 
active  stage,  which  will  not  reproduce  those  secondary 
phases  so  dangerous  as  regards  contagion,  heredity,  etc. 
Consequently,  my  apprehensions,  so  far  as  relates  to  mar- 
riage, are  by  so  much  diminished. 

I  will  add  that  this  period  of  immunity  will  satisfy  me 
much  better  still,  if  it  has  coincided  with  a  prolonged 
suspension  of  specific  treatment,  for  then  it  assumes  a 
much  more  significant  import ;  it  testifies  that  the  disease, 
even  when  left  to  its  own  course,  and  independently  of  all 
repressive  influence  of  treatment,  has  shown  no  tendency 
to  reproduce  its  manifestations.  And  this  is  not  with- 
out an  important  interest  for  us.  We  know,  in  fact,  that 
there  are  certain  cases  of  syphilis,  which,  at  the  same  time 
tractable  and  rebellious  to  the  action  of  our  remedies,  seem 
to  be  cured  when  they  are  treated,  only  to  burst  forth 
anew  soon  after  the  suppression  of  treatment.'-^  "We  must 
distrust  this  class  of  cases,  and  not  forget  that  an  immu- 
nity prolonged,   without  any  tlierapeutic  intervention, 

*  There  are,  without  doubt,  certain  cases  of  syphilis  in  which  one  can  not,  so  to 
speak,  relax  the  treatment  beyond  a  certain  time  without  the  occurrence  of  a  new 
outbreak.  So  long  as  they  are  subjected  to  specific  treatment  they  remain  inactive. 
But  let  this  treatment  be  suspended,  and  almost  immediately — or,  at  least,  after  a 
certain  time — they  develop  new  symptoms.  It  will  be  necessary  to  always  continue 
treating  them,  in  order  to  keep  them  quiet.  Now,  from  our  present  point  of  view, 
what  guarantee  does  an  immunity  due  to  &  permanent  therapeutic  influence  afford 
in  such  cases  ?  Should  we  allow  a  patient  affected  with  a  syphilis  of  this  kind  to 
marry,  basing  our  decision  upon  the  twofold  guarantee  of  a  long  immunity  and  a 
protracted  treatment  ?  But  it  may  happen  that,  so  soon  as  the  treatment  is  sus- 
pended, new  accidents  may  be  produced,  with  all  their  consequent  dangers.  Then, 
indeed,  the  marriage  should  not  be  tolerated,  except  in  the  special  condition  that  a 
long  period  shall  have  passed  without  accidents,  and  that,  too,  loithout  any  thera- 
peutic intervention. 

The  forms  of  syphilis  to  which  I  have  just  alluded  are  not  absolutely  rare.  It 
is  necessary  to  distrust  them  when  met  with  in  practice,  as  long  as  they  preserve 
their  active  characteristics  and  their  tendency  to  continued  recurrences. 


98  SYPHILIS  AND  MARRIAGE. 

alone  constitutes  a  veritably  substantial  guarantee  with 
relation  to  marriage. 

This  point  stated  as  a  principle — viz.,  the  necessity 
of  a  certain  period  of  complete  immunity  before  marriage 
— I  anticipate  that  here  again,  as  before,  you  are  about 
to  demand  the  figures  of  me,  to  insist  upon  a  precise 
length  of  time,  and  say,  "What,  then,  in  your  opinion, 
ought  to  be  the  exact  duration  of  this  period  of  immunity, 
of  this  sort  of  probational  stage  which  you  requu-e  of  your 
patient?" 

Now,  here  again,  as  before,  I  can  only  partly  satisfy 
you.  I  must  confine  myself  to  answering  only  what  I  am 
justified  in  answering,  viz.,  that — 

1.  It  would  be  impossible  to  lay  down  a  fixed,  precise 
term.  One  must,  from  the  very  nature  of  such  questions, 
depend  upon  approximative  averages  mthin  sufficiently 
wide  limits. 

2.  The  longer  this  period  of  immunity,  the  more  reas- 
suring will  it  be  in  every  respect,  especially  as  affecting 
the  question  of  marriage. 

3.  Finally,  in  order  to  fix  a  minimum,  I  conclude,  from 
my  personal  observation,  that  it  would  be  imprudent  to 
reduce  this  period  of  complete  immunity  to  less  than  from 
eigliteen  months  to  tioo  years.  Eighteen  months  to  two 
years  passed  without  any  accident,  without  any  awaken- 
ing of  the  diathesis,  seems  to  me  a  strictly  necessary 
minimum  which  should  be  rigorously  required  of  every 
syiDhilitic  subject  before  allowing  him  to  marry. 

Moreover,  let  us  note  well  that  the  duration  of  this 
stage  of  morbid  immunity  naturally  rests  subject  to  varia- 
ble conditions.  It  should  be  longer  or  shorter  with  differ- 
ent patients,  and  the  physician's  duty  will  be  to  proportion 
it  to  the  exigencies  of  each  particular  case.     It  is  evident, 


PBOLONOED  PERIOD   OF  IMMUNITY.  99 

for  example,  that  we  shall  be  justified  in  extending  it 
longer  if  the  most  recent  accidents  presented  by  the  patient 
have  been  of  a  serious  nature  ;  or,  again,  if  the  diathesis, 
in  general,  has  assumed  a  threatening  character.  And, 
conversely,  also,  we  can  depart  from  such  a  severity  in 
cases  where  the  conditions  are  directly  opposite. 

But  I  perceive  that  we  are  about  to  encroach  upon  the 
fourth  point  of  my  programme  with  considerations  of  this 
kind.     Let  us  reserve  them  for  the  next  section. 

Fourth  condition :  Non-meistacing  character  of  the 

DIATHESIS. 

Evidently  there  is  syphilis  and  syphilis,  as  has  been  so 
often  said  and  repeated,  especially  in  our  day. 

There  is,  unquestionably,  a  'benign  sypliilis  and  a 
gram  sypJiilis. 

There  are  light,  benign  cases  of  syphilis,  which,  how- 
ever little  they  may  be  subjected  to  treatment,  limit  their 
manifestations  to  a  small  number  of  external,  superficial, 
and  unimportant  accidents ;  while  there  are,  also,  grave 
cases  of  syphilis,  which,  although  systematically  and 
energetically  treated,  none  the  less  determine  serious  and 
important  manifestations — doubly  important  both  on  ac- 
count of  the  number  and  of  the  character  of  their  acci- 
dents. 

JN'ow,  the  quality  (permit  me  the  word),  the  quality,  I 
say,  of  the  syphilis  with  which  a  patient  has  been  affected 
is  far  from  being  without  interest  in  deciding  the  special 
question  which  now  engages  our  attention.  Quite  the 
contrary ;  it  has  a  superior  significance  in  this  matter — 
a  significance  very  essential  to  appreciate,  and  to  which 
there  is  reason  to  attach  great  importance  in  the  solution 
of  our  problem. 

And,  in  fact,  given  the  case  of  a  patient  who  comes  to 


100  SYPHILIS  ANI>  MARIilAOE. 

ask  our  advice  upon  the  propriety  of  marriage,  if  tlie  syph- 
ilis with  which  he  has  been  affected  has  been  only  average 
or  light,  if  it  has  been  limited  to  a  small  number  of  crops, 
if  the  accidents  composing  these  crops  have  been  super- 
ficial and  benign,  if  the  diathesis  has  shown  itself  tractable 
to  treatment,  and  readily  and  rapidly  amends  under  the 
influence  of  therapeutic  agents,  we  have  here,  unquestion- 
ably, so  many  excellent  conditions  which  ought  to  influ- 
ence our  judgment  favorably.  This  ensemble  of  benignity 
is  well  adapted,  assuredly,  to  insi^ire  confidence,  and  in- 
duce, the  physician  to  depart,  almost  in  spite  of  himself, 
from  the  severity  usually  necessary  in  so  serious  a  situa- 
tion. The  past  seems  here  a  guarantee  of  the  future,  and 
compels,  if  I  may  thus  express  it,  his  acquiescence  in  the 
marriage. 

Indeed,  this  is  only  Justice,  for,  according  to  experi- 
ence, the  progTiostications  of  good  augury  deduced  from 
antecedents  so  favorable  are  almost  always  confirmed  by 
subsequent  developments,  especially  when  the  patient 
counts  among  his  assets  a  long  and  careful  treatment. 

Nevertheless,  one  should  not  go  too  far  in  this  direc- 
tion. Certainly,  an  original  benignity  of  a  syphilis  con- 
stitutes a  favorable  condition  for  marriage,  but  it  con- 
stitutes no  more  than  this ;  it  does  not,  of  itself  alone, 
sui^ply  the  place  of  the  other  requirements  of  the  complex 
programme  which  we  are  studying.  To  trust  to  this 
alone,  in  permitting  marriage,  would  be  a  grave  impru- 
dence, which  would  lead  to  the  most  unhappy  conse- 
quences ;  and  I  regret  to  say  that,  in  practice,  this 
imprudence  is  too  frequently  committed,  the  proofs  of 
which  I  have  in  my  possession.  I  shall  not  hesitate  to 
insist  upon  this  point,  and  I  repeat  that,  however  benign 
may  have  been  a  syphilis  in  its  earlier  stages,  one  is  not 


NON-MEFAOma   GEARAGTER  OF  TEE  DIATEE8I8.    101 

anthorized  by  tliis  fact  alone,  by  this  sole  condition,  with- 
out more  ample  investigation,  without  requirements  of 
another  kind,  to  permit  marriage.  In  spite  of  this  benig- 
nity, which  I  have  just  recognized,  and  the  importance  of 
which,  from  our  present  point  of  view,  I  again  affirm,  it  is, 
in  my  opinion,  no  less  necessary  that  the  patient  fully 
satisfy  other  general  conditions  to  which  every  syphilitic 
candidate  for  marriage  is  subject.  This  is  indispensable, 
and  here  is  the  reason : 

On  the  one  hand,  experience  teaches  us  that  cases  of 
syphilis,  originally  benign,  may  reveal  themselves,  more 
or  less  tardily,  by  severe  manifestations,  if  they  have  not 
been  subjected  to  an'  active  and  prolonged  treatment. 
And  it  has  been  often  seen  that  a  syphilis  of  this  kind 
negligently  treated,  on  account  of  its  apparent  benignity, 
becomes  later  on  singularly  dangerous  in  marriage  from 
the  double  point  of  view  of  contagion  and  Tieredity. 

On  the  other  hand,  and  this  is  no  less  important, 
these  same  cases  of  syphilis,  inoffensive  in  appearance  at 
first,  nevertheless  present  a  dark  outlook  for  the  future, 
and  this  dark  outlook  (permit  me  the  expression)  relates 
to  the  personal  risJcs  of  the  liusband.  I  will  explain  my 
meaning. 

It  is  now  thoroughly  proved — (and  you  will  do  me  the 
justice,  I  trust,  to  admit  that  I  have  contributed  in  part  to 
this  important  demonstration) — it  is  to-day  well  proved,  I 
say,  that  the  initial  benignity  of  a  syphilis  by  no  means 
constitutes  an  absolute  guarantee  for  the  future.  Such  a 
syphilis,  although  beginning  well,  is  no  less  liable  on  that 
account  to  end  badly.  ^    It  is  thus  very  frequently  that 

*  This  is  a  point  upon  whicli  I  do  not  cease  to  insist  in  all  my  courses  of  lec- 
tures.    I  have  studied  and  developed  it  at  length  in  my  Legons  sur  la  syphilis  chez 
lafemme^  and  in  this  work  will  be  found  a  long  series  of  observations  relative  ta 
8 


102         .  SYPHILIS  AND  MARRIAGE. 

one  observes  patients  who,  while  presenting  at  the  debut 
of  the  diathesis  only  slight,  almost  insignificant  secondary- 
accidents,  are  affected  after  a  long  interval — ten,  fifteen,  or 
twenty  years  later,  with  the  most  severe  tertiary  manifes- 
tations. Cerebral  syphilis,  for  example,  as  I  have  shown 
in  a  recent  publication,'^  seems  to  affect  from  preference 
subjects  with  specific  antecedents  of  an  unusual  benignity. 
It  is  likewise  the  case,  as  I  hope  to  show  you  soon,  with 
syphilis  of  the  spinal  cord.  And,  besides,  gentlemen,  I 
am  now  preaching  to  those  who  ought  to  be  converts,  for 
I  am  speaking  to  the  pupils  of  the  Saint  Louis,  of  the 
hospital  which  is  the  chosen  refuge  of  old  syphilitics. 
Now,  do  we  not  encounter  here,  almost  daily,  patients 
affected  ^dth  tertiary  lesions  of  every  character,  and  with 
tertiary  lesions  unfavorable  in  prognosis  local  or  general, 
yet  whose  syphilis  commenced  the  most  light,  the  most 
benign,  the  most  favorable  in  appearance  ?  So  true  is  this, 
that  among  numbers  of  them  we  have  great  difficulty  even 
in  determining  the  original  date  of  their  disease — a  date 
almost  forgotten,  not  only  by  reason  of  its  chronological 
distance,  but  by  reason  of  the  trifling  importance  of  the 
accidents  which  signalized  it. 

Those  curious  cases  of  syphilis  which,  after  having 
been  characterized  by  a  singular  initial  benignity,  have 
finally  ended  in  the  gravest  accidents,  have  been  discussed 
at  length.  For  my  part,  I  see  nothiDg  extraordinary  in 
them  ;  and  I  consider  them  simply  cases  of  syphilis  which, 

patients  who,  presenting  at  the  debut  of  the  diathesis  only  the  shghtest  and  most 
benign  accidents,  have  afterward  experienced  the  severest  forms  of  the  tertiary 
stage,  p.  1012. 

*  La  syphilis  dn  cerveau,  clinical  lectures  recorded  by  E.  Brissaud,  Paris,  1879. 
M.  Broadbeut  professes  a  similar  opinion.  "  From  the  cases  which  I  have  seen," 
he  writes,  "  I  have  formed  this  opinion,  viz.,  that  the  subjects  most  exposed  to 
accidents  of  the  nervous  system  are  those  in  whom  the  secondary  symptoms  have 
been  transitory  or  light." 


NON-MENAGINQ   GEARACTER   01   TEE  DIATEESIB.    103 

having  been  insufficiently  treated,  on  account  of  their  ap- 
parent benignity,  have  afterward  resulted  in  those  acci- 
dents vv^hich  every  syphilis  not  treated  may  determine. 

At  all  events,  from  the  foregoing  facts  we  may  deduce 
this  definite  and  important  conclusion,  viz.  :  that  the  ini- 
tial benignity  of  a  syphilis  does  not  constitute  a  pledge  of 
security  for  marriage,  if  it  he  not  joined  with  addition- 
al guarantees— notably  that  of  a  sufficient  treatment. 
After  these  remarks  upon  benign  syphilis,  we  come  now 
to  the  study  of  syphilis  of  a  directly  opposite  character. 

There  is,  I  have  said,  a  bad  syphilis  for  marriage. 
This  bad  syphilis  (I  retain  the  word  and  explain  it)  com- 
prises all  those  cases  which,  from  various  causes,  are  more 
liable  than  others  to  become  dangerous  in  marriage. 

What  are  they?  They  are  numerous  and  of  various 
orders.  I  can  not  enumerate  them  all,  for  one  can  not 
foresee  them  all,  and  the  particular  cases  are  multiple  and 
infinitely  variable.  But  I  will  cite  here  the  principal  ones, 
those  which  it  is  essentially  important  to  recognize,  in 
order  to  distrust  them,  in  order  to  guard  against  them  in 
the  solution  of  the  problem  which  we  are  now  studying : 

1.  In  the  first  place,  bad  for  marriage  are  certain  cases 
of  syphilis  which,  without  being  severe,  present  an  un- 
usual tendency  to  continual  reproduction — to  a  ready, 
repeated,  and  almost  incessant  multiplication  of  various 
accidents  of  the  secondary  stage,  notably  erosions  of  the 
mucous  surfaces. 

It  is  thus  that  certain  subjects  remain  exposed  during 
many  consecutive  years,  sometimes  even  in  spite  of  the 
best  regular  treatment,  to  erosive  lesions,  localized  espe- 
cially in  the  mouth,  affecting  more  rarely  the  genital  mu- 
cous surface.  These  lesions  are  always  superficial,  limited, 
benign  ;  they  are  cured  with  the  utmost  facility  under  the 


104       ,  SYPHILIS  AND  MARRIAGE. 

influence  of  cauterization,  aided  by  certain  local  attention, 
but  tliey  are  cured  only  to  be  reproduced,  to  be  incessantly 
renewed.  Intrinsically,  tliey  are  of  no  importance ;  but, 
for  all  that,  they  are  none  the  less  dangerous  as  regards 
contagion. 

Such  is  the  case,  for  example,  of  a  patient  that  I  have 
been  treating  for  a  long  time. 

This  young  man  has  been  affected  for  five  years  with  a 
syphilis  which  one  would  be  justified  in  classing  as  benign, 
since,  after  the  initial  chancre,  it  has  never  shown  itself 
except  by  a  roseola,  a  palmar  syphilide  of  light  intensity, 
and  buccal  mucous  patches.  He  has  been  under  treatment 
almost  from  the  debut  of  the  disease,  and  quite  regularly. 
Several  times  he  has  been  subjected  by  me  to  an  active 
mercurialization  (fifteen  to  twenty  centigrammes  of  the 
proto-iodide  daily).  Now,  despite  this  treatment,  despite 
all  my  efforts,  this  patient  (who  is  a  smoker,  a  circumstance 
essential  to  note)  has  not  for  five  years  past  ceased  to  be 
affected  with  lingual  syphilides,  with  repetitions  almost 
unremitting,  I  cure  him  of  one  crop ;  a  month  or  two 
later  a  new  crop  invades  the  tongue,  Tlien,  new  treat- 
ment, new  cure  ;  then,  rapid  return  ;  and  so  on  in  succes- 
sion. In  brief,  I  always  cure  him,  and  "always  have  to 
begin  again,"  according  to  his  o"\vn  expression.  After 
long  resistance,  upon  my  earnest  entreaty,  he  entirely  re- 
nounced the  use  of  tobacco.  The  crops  then  became  less 
frequent,  but  did  not  entirely  cease.  And,  recently,  I  have 
again  seen  him,  with  the  syphilides  covering  almost  the 
whole  dorsal  surface  of  the  tongue. 

Now,  what  would  have  happened  if  I,  trusting  to  the 
comparative  benignity  of  this  syphilis  and  the  activity  of 
its  regular  treatment,  had  allowed  this  patient  to  marry  in 
the  interval  between  two  crops  of  these  accidents  %    I  have 


NON-MENAOINa   CHARACTER   OF  THE  DIATHESIS.    105 

not  to  predict,  theoretically,  wliat  would  have  happened, 
for  I  have  had  a  practical  demonstration.  This  young 
man  last  year  took  for  a  mistress  a  young  vt^oman  until 
then  perfectly  healthy  and  free  from  every  venereal  acci- 
dent. Some  weeks  later  he  brought  her  to  me  affected 
with  an  indurated  labial  chancre,  a  chancre  evidently 
derived  by  contagion  from  the  lingual  syphilides  of  my 
patient. 

2.  Equally  bad  for  marriage  are  the  numerous  varieties 
of  syphilis  which,  in  various  respects,  one  may  character- 
ize as  grave  :  grave  it  may  be  on  account  of  the  multiplici- 
ty and  intensity  of  their  accidents  (precocious,  malignant 
syphilis,  for  example) ;  it  may  be  on  account  of  the  nature 
of  their  manifestations  (ulcerations,  deep,  extensive,  pha- 
gedenic, menacing,  etc.);  it  may  be  on  account  of  their 
precocious  tendency  to  the  visceral  form,  or,  more  gener- 
ally, to  morbid  determinations  which  ordinarily  occur 
only  in  an  advanced  age  of  the  diathesis ;  it  may  be  on 
account  of  the  reaction  which  they  exert  upon  the  consti- 
tution, the  nutrition,  the  health  (syphilis  of  an  asthenic, 
depressive,  innutritive  form,  etc.) ;  it  may  be  on  account 
of  their  character  of  obstinacy  to  treatment ;  it  may  be, 
finally,  on  account  of  such  or  such  other  peculiarities,  in- 
finitely variable,  but  all  presenting  this  common  quality, 
all  unequivocally  testifying  to  an  unusual  intensity,  to  a 
real  malignity,  even,  of  the  diathesis. 

3.  Bad  again,  more  particularly  from  the  same  point 
of  view,  are  those  cases  of  syphilis  which  elect  for  their 
morbid  determinations  some  important  organ,  such  as  the 
eye,  the  brain,  the  spinal  cord,  etc. 

The  cases  of  syphilis  with  ocular  localizations,  for  ex- 
ample, are  very  often  remarkable  for  their  obstinacy,  for 
their  tenacity,  for  their  relapses  after  cure,  and  altogether 


106  SYPHILIS  AND  MARRIAGE. 

by  the  serious  functional  troubles  whicli  they  leave  in  their 
train.  ISTumbers  of  times  have  I  seen  them  result  in  com- 
plete blindness,  despite  the  most  energetic  treatment  and 
the  efforts  of  the  most  skiLTful  ophthalmologists. 

What  is  to  be  said  of  cerebral  syphilis  ?  Every  locali- 
zation of  the  diathesis  toward  the  brain  presages  the  most 
serious  results  both  for  the  present  and  for  the  future. 
To  be  sure,  a  cerebral  syphilis,  even  though  very  grave, 
can  be  cured  ;  I  have  cited  examj)les  of  this.  But,  in  the 
first  place,  how  can  it  be  cured  ?  At  the  price  of  a  most 
active  treatment — of  a  treatment  which  must  be  pro- 
longed, which  must  be  resumed  after  the  cure  many  and 
many  times  ;  and  more,  at  the  price  of  a  s^Decial  hygiene, 
upon  which  I  have  elsewhere  insisted  at  length,  and  which 
requires  an  observance  almost  indefinite  in  duration.* 
Then,  the  cure  obtained,  there  still  remains  the  chapter 
of  recurrences,  and  recurrences  in  this  form  of  the  disease 
are  the  most  common,  and  at  the  same  time  the  most 
serious.  Many  a  patient,  who  resists  the  first  assault  of 
the  diathesis  upon  the  brain,  succumbs  to  a  second  or  to  a 
third.  These  recurrences  are  so  habitual  that  they  almost 
constitute  the  rule  f — hence,  in  all  other  respects,  as  well 
as  in  relation  to  the  question  of  marriage,  the  particularly 
serious  prognosis  of  every  cerebral  manifestation  depen- 
dent upon  syphilis. 

So,  when  consulted  upon  the  propriety  of  marriage  by 
a  subject  who  gives  a  history  of  such  or  such  symptoms  of 
cerebral  syphilis  in  his  specific  antecedents,  the  physician 
ought  more  than  ever  to  be  armed  with  prudence  and  firm- 
ness. In  my  opinion,  from  my  own  observation,  every  spe- 
cific manifestation  toward  the  brain  constitutes  an  almost 
express  interdiction  to  marriage  by  reason  of  the  future 

*  V.  Syphilis  du  cerveau,  p.  590.  f  Vide  same  work,  p.  628. 


NON-MENACma   CHARACTER   OF  THE  DIATHESIS.    107 

consequences  to  which  it  leaves  the  patient  exposed.  For 
my  part,  I  would  most  energetically  dissnade  from  all  de- 
signs of  marriage  any  man  who,  even  though  cured  of  his 
syphilis,  had  disclosed  to  me  undoubted  accidents  of 
specific  encex3halopathy  in  his  past  history,  such  as  an 
epileptiform  attack,  an  apoplectiform  stroke,  hemiplegia, 
mental  affections,  etc.  Such  accidents  are,  in  my  opinion, 
^^oluielj  incompatible  with  marriage.  I  will  not  even 
discuss  the  supposition  of  a  possible  marriage  under  these 
conditions. 

But  if,  nevertheless,  the  diathesis,  although  positively 
affecting  the  brain,  has  limited  itself  to  the  most  super- 
ficial expressions,  to  the  lightest,  most  benign  functional 
troubles,  then  only  should  I  consider  myself  justified  in 
departing  from  an  absolute  interdiction.  But,  even  then, 
I  should  not  grant  my  consent  until  after  a  mature  analy- 
sis of  the  clinical  features,  and  the  fulfillment  of  certain 
express  conditions,  such  as  the  following :  if  the  patient 
is  absolutely  cured  of  every  cerebral  trouble ;  if  he  has 
been  a  long  time  cured— that  is  to  say,  several  years  at  the 
minimum  ;  if,  since  then,  no  new  accident,  however  slight, 
has  occurred  ;  if  the  most  energetic  treatment  has  been 
followed  since  the  cure ;  if  a  long  period  of  immunity  after 
the  suspension  of  the  treatment  appears  to  prove  a  com- 
plete cure,  etc.  And  still — I  confess  it — even  in  spite  of 
these  guarantees,  it  would  be  not  without  a  secret  appre- 
hension— it  would  be  only  reluctantly,  and  with  a  veri- 
table regret — that  I  should  allow,  upon  my  ovyTQ.  respon- 
sibility, a  patient  who  had  been  affected  with  such  acci- 
dents to  engage  himself  in  marriage. 

In  this  matter,  gentlemen,  you  will  perhaps  say  that  I 
am  very  strict.  But  I  will  reply  to  you,  once  for  all,  that 
we  must  be  strict  now  or  never  when  it  concerns  (1)  an 


108  SYPHILIS  AND  MARRIAOE. 

optional  act  sucli  as  marriage,  to  which,  no  one  is  com- 
pelled except  by  his  own  free  will  and  his  individual  con- 
venience ;  (2)  of  multiple  and  important  interests  involving 
the  future  of  an  entii^e  family.  At  all  events,  I  do  not 
thus  speak  to  you  without  being  authorized  to  do  so  by 
lamentable  and  painful  examples.  Such  are  the  two  fol- 
lowing, among  many  others,  which  I  desire  to  make  known 
to  you : 

A  young  man,  syphilitic  for  nine  years,  having  pre- 
sented only  slight  specific  accidents,  and  never  having 
been  treated,  except  in  a  very  insufficient  manner,  sud- 
denly experiences  symptoms  of  a  cerebral  character.  One 
day,  in  hunting,  he  perceives  that  he  can  no  longer  carry 
his  gun  in  his  left  hand.  His  left  arm,  without  being 
completely  paralyzed,  has  become  suddenly  inert,  be- 
numbed, "half  dead."  An  energetic  treatment  (mercu- 
rial fi'ictions  and  iodide)  is  resorted  to  immediately,  and 
promptly  corrects  these  accidents.  The  year  following, 
there  is  a  return  of  the  same  symptoms.  After  many  rejDe- 
titions  of  the  same  kind,  he  experiences  an  embarrassment 
in  the  use  of  his  tongue,  with  sputtering  and  stammering, 
and  a  difficulty  in  finding  and  articulating  words.  A  new 
treatment  of  the  same  kind,  and  all  disappears.  The  pa- 
tient then  writes  to  me  to  consult  me  uioon  the  subject  of 
a  marriage  which  is  proposed  to  him.  I  strongly  advise 
him  to  let  such  projects  di'op.  I^otwithstanding,  he  goes 
his  own  way  and  marries.  Now,  ten  days  after  his  mar- 
riage he  is  suddenly  seized  with  cerebral  accidents  of  the 
utmost  gravity :  apoplectiform  stroke,  hemiplegia,  com- 
plete amnesia,  intellectual  troubles,  etc.  In  spite  of 
treatment,  all  these  phenomena  persist,  and  become 
aggravated.  Progressive  intellectual  depression,  general 
enfeeblement,  death  from  dementia  six  months  later. 


NON-MENAOma   GHABAOTEB   OF  THE  DIATHESIS.    109 

Second  case,  almost  identical  with  the  preceding.  A 
young  man,  syphilitic  since  1863,  is  taken  in  1870  with  a 
violent  attack  of  cephalalgia,  with  incomplete  paralysis  of 
the  third  pair  (external  strabismus,  mydriasis,  diplopia). 
I  treat  him,  and  I  have  the  happiness  to  cure  him  rapidly. 
At  this  time  he  leaves  Paris,  and  I  entirely  lose  sight  of 
him.  In  the  country  he  marries,  in  opposition  to  the  ad- 
vice of  one  of  my  former  pupils,  consulted  upon  this  sub- 
ject. Some  years  later  (in  1875)  I  am  again  summoned  to 
see  him,  and  I  find  him  in  the  most  lamentable  situation : 
left  hemiplegia,  amnesia,  psychic  troubles,  hebetude,  etc. 
A  vigorous  treatment  is  then  instituted,  and  pursued  for  a 
long  time.  The  patient' s  life  is  saved,  but  he  remains  with 
his  left  arm  weakened  and  his  intellect  enfeebled.  ]N"o 
longer  capable  of  managing  his  affairs,  he  has  liquidated 
his  business,  not  without  great  material  losses  ;  so  that  to- 
day, with  a  wife  and  two  children  in  his  charge,  he  vege- 
tates in  a  situation  the  most  deplorable,  almost  allied  to 
misery. 

What  I  have  Just  said  of  syphilitic  aifections  of  the  eye 
and  the  brain  as  so  many  contraindications  to  marriage,  I 
could  repeat  literally  respecting  the  specific  lesions  of  the 
medulla,  which  also  are  specially  remarkable  for  their  ob- 
stinacy, their  recrudescences,  their  recurrences,  and  which 
also  frequently  terminate  in  the  most  serious  infirmities. 
To  convince  you  of  this,  I  would  recall  the  case  of  the  un- 
fortunate patient  now  lying  in  bed  N"o.  27  of  Saint-Louis 
ward.  Affected  at  three  different  times  with  paraplegic 
symptoms,  which  depend,  from  all  the  evidence,  upon  an 
old  syphilis,  he  recovered  three  times,  thanks  to  an  ener- 
getic treatment,  prescribed  in  turn  by  M.  Yidal,  by  M.  A. 
Guerin,  and  by  myself.  A  fourth  time  within  the  past 
year  the  same  accidents  are  again  renewed,  but  with  an 


no  SYPHILIS  AND  MARRIAGE. 

added  intensity.  So  that,  despite  a  most  active  medica- 
tion, notwithstanding  all  that  I  can  do  for  him,  the  pa- 
tient finds  himself  to-day  in  a  situation  almost  absolutely 
desperate,  even  under  the  menace  of  a  fatal  termination 
that  can  not  be  long  delayed. 

After  these  different  examples  which  I  have  just  cited, 
it  would  be  useless,  I  think,  to  continue  this  enumeration. 
The  foregoing  facts  ought  to  suffice  amply  for  the  demon- 
stration of  the  proposition  which  I  wish  to  establish,  viz., 
that  a  certain  kind  of  syphilis,  and  even  a  certain  class  of 
syphilitic  symptoms,  are  of  a  nature  to  make  the  physician 
very  circumspect  and  very  strict  in  the  verdict  which  he 
is  called  upon  to  render  as  to  a  syphilitic' s  fitness  for 
marriage. 

One  of  the  essential  elements  of  such  a  verdict  lies,  as 
we  have  Just  demonstrated,  in  the  appreciation  of  the  in- 
trinsic prognosis  of  each  particular  case — in  the  exact 
determination — at  least  as  exact,  as  precise  as  possible — 
of  the  quality  of  the  syphilis  which  affects  the  patient, 
who  comes  to  seek  our  advice  and  submit  his  destinies  to 
our  direction. 

It  is,  then,  the  business  of  the  man  of  art,  in  such  cir- 
cumstances, to  inform  himself  as  thoroughly  as  possible 
upon  his  patient's  antecedents  and  upon  the  nature  of  the 
accidents  which  he  has  presented.  It  is  his  business  to 
prepare  from  a  careful  and  minute  inventory  what  I  will 
call  t\LQ  pathological  balance- slieet  of  his  patient,  to  judge 
of  the  quality  of  the  diathesis  under  observation ;  then, 
this  analysis  made,  to  decide  finally  whether,  from  a  med- 
ical point  of  view,  there  is  reason  to  consider  said  diathesis 
dangerous  for  marriage  or  not. 

In  this  matter  there  are  no  general  rules  to  lay  down  ; 
for  here  all  depends  upon  the  individual  case  and  the  par- 


NON-MENACING   CHARACTER   OF  THE  DIATHESIS.    HI 

ticular  circumstances  whicli  surround  it,  and  all  remains 
subject  to  the  knowledge,  to  the  tact,  to  the  experience  of 
the  physician. 

Here  is  the  true  clinical  aspect  of  the  problem,  and  I 
need  not  speak  of  the  considerable  importance  which 
attaches  to  it 


CHAPTER  X. 

SUFFICIENT   SPECIFIC   TEEATMENT. 

Fifth  Condition :  Sufficieistt  Specific  Treatment. — 
A  treatment  sufficiently  prolonged,  a  treatment  sufficiently 
protective,  sncli  is  the  fifth  and  last  condition  of  our  pro- 
gramme. And  this,  certainly,  is  the  great  condition  par 
excellence.  For,  after  all,  in  the  problem  which  we  are 
studying  all  converges,  all  reverts  to  this  question :  a 
syphilitic  patient  aspiring  to  marriage,  is  he  or  is  he  not 
sufficiently  well  cured  of  his  diathesis  to  be  no  longer  dan- 
gerous in  marriage  ?  From  this  point  of  view  the  ques- 
tion of  the  admissibility  to  marriage  of  a  syphilitic  subject 
is  almost  equivalent  to  the  cure  or  the  non-cure  of  his  dis- 
ease. We  shall  not,  in  consequence,  have  to  spend  much 
time  in  demonstrating  that  which  no  longer  requires  to  be 
demonstrated — that  which  is  to-day  accepted  by  every  one, 
viz.,  that  the  treatment  termed  specific  does  in  a  general 
manner  diminish  and  avert  the  dangers  of  syphilis. 

"\Vhence  results  this  quite  natural  corollary  concerning 
our  subject :  specific  treatment  diminishes  or  averts  the 
dangers  of  syphilis  in  relation  to  marriage.  It  confers 
upon  a  patient  formerly  affected  with  syphilis  the  most 
valuable  and  the  most  substantial  guarantee  of  his  fitness 
for  marriage. 

This  proposition  will  find  its  proofs  in  the  several  con- 
siderations following : 


SUFFICIENT  SPEOIFIG  TREATMENT.  113 

I.  In  the  first  place,  according  to  all  evidence,  specific 
treatment  constitutes  the  best  safeguard,  the  surest  guar- 
antee against  the  personal  risks  which  affect  the  husband 
in  the  relation  of  marriage. 

To  be  convinced  of  this,  it  suffices  to  compare,  in  an 
advanced  stage  of  their  evolution,  cases  of  syphilis  treated 
and  cases  of  syphilis  not  treated/'  Exception  made  of 
certain  cases  which  baffle  all  our  therapeutic  efforts,  one 
may  say  that  a  syphilis  treated  (I  mean  treated  with 
method,  energy,  and  perseverance)  will  not  have  a  tertiary 
period.  Beyond  a  variable  number  of  initial  crops,  it 
produces  nothing  more  ;  it  becomes  and  remains  quiet,  and 
the  patient,  henceforth  exempt  from  accidents,  seems  to 
have  been  restored  to  the  ordinary  conditions  of  health. 
Quite  on  the  contrary,  syphilis  treated  insufficiently,  or 
not  at  all,  terminates  certainly,  constantly,  in  grave  ter- 
tiary lesions  at  a  period  more  or  less  advanced. 

The  tertiary  period  is  the  time  of  maturity,  when  the 
indifferent,  negligent  syphilitic  pays  his  accumulated  debt 
to  the  disease,  and  "  the  pox,"  as  M.  Ricord  has  said,  "is 
a  pitiless  creditor,  and  grants  grace  to  no  one."  What 
examples  of  this  kind  have  you  not  here  under  your  eyes  ! 
What  of  tertiary  lesions  here  in  our  wards  !  And  almost 
all  consecutive  to  cases  of  syphilis  carelessly  treated  in 
their  early  stage,  or  even  (which  is  not  rare)  absolutely 
undisturbed  by  any  treatment. 

But  we  leave  the  consideration  of  this  point,  which,  I 
repeat,  is  now  admitted  by  every  one,  save  very  rare  and 
almost  unaccountable  exceptions. 

*  See  upon  this  subject,  in  my  Legons  sur  la  syphilis  chez  lafemme,  a  long  chap- 
ter devoted  to  a  parallel  drawn  between  the  cases  of  syphilis  treated  and  those  not 
treated.  I  think  I  have  there  demonstrated — as  so  many  others  have  done — the 
inestimable  benefits  of  a  systematic  treatment,  no  less  than  the  disastrous  conse- 
quences of  a  system  of  expectation  when  applied  to  the  pox  (p.  1052,  and  following). 


114  SYPHILIS  AND  MARRIAGE. 

II.  It  is  no  less  evident  that  specific  treatment  dimin- 
ishes and  suppresses  the  chances  of  contagion  in  marriage. 
In  effect,  a  large  majority,  if  not  all,  patients  submitted 
to  specific  treatment  very  quickly  acquire  an  immunity. 
Look  at  what  takes  place  in  every-day  practice.  A  pa- 
tient comes  to  us  in  the  full  secondary  stage,  and  we  sub- 
ject him  to  the  usual  treatment.  What  is  the  result,  at 
least  nineteen  times  out  of  twenty  ?  In  the  first  place,  the 
patient  remains  subject  during  the  course  of  the  first  few 
months,  sometimes  even  during  the  first  year,  to  secondary 
crops,  more  or  less  numerous,  more  or  less  intense,  accord- 
ing to  the  quality  of  the  diathesis,  but,  generally,  they  are 
lessened  and  rendered  milder  by  the  treatment.  Then, 
afterward,  from  about  the  second  year,  the  crops  com- 
mence decreasing ;  they  are  limited  to  a  few  isolated  and 
benign  manifestations — for  examiDle,  to  certain  buccal  ero- 
sions. Then,  again,  later  on,  the  calm  becomes  more  pro- 
nounced ;  it  becomes  complete  with  the  third,  or,  later, 
with  the  fourth  year.  After  that  time  it  is  all  over  with 
the  secondary  period  ;  and  with  it  are  finished  those  con- 
tagious accidents  which  it  comprises,  and  which  constitute 
the  principal  danger  relative  to  marriage.  Such  is  the 
rule. 

That  there  are  exceptions  to  this  rule  I  know  only  too 
well,  and  I  have  given  examples  of  them  previously  (vide 
page  104).  But  these  exceptions  are  always  rare ;  and, 
moreover,  they  belong  to  that  class  of  cases  which  I  have 
pointed  out  to  you  as  constituting  the  contraindications 
to  marriage. 

III.  In  the  same  way,  finally,  specific  treatment  dimin- 
ishes and  suppresses  the  Jiereditary  risks  of  syphilis. 

In  the  first  place,  this  is  superabundantly  demonstrated 
in  the  case  of  paternal  hereditary  syphilis.     Recall,  as 


SUFFICIENT  8PFGIFIG  TREATMENl.  115 

examples,  those  very  convincing  cases  of  wMcli  I  liave 
previously  spoken  to  you,  a^nd  whicli  may  thus  be  recajjit- 
ulated :  A  healthy  woman  aborts  many  times  in  succession 
without  cause  and  without  explanation.  We  become  un- 
easy ;  we  search  for  the  wherefore  of  these  successive 
abortions,  and  we  find  no  other  possible  explanation  than 
the  syphilis  of  the  husband.  Empirically,  the  husband  is 
then  submitted  to  a  severe  specific  treatment.  Wew  preg- 
nancies occur,  and  these  terminate  altogether  favorably — 
that  is  to  say,  they  produce  at  full  term  healthy  children. 
What  more  convincing  ? 

Now,  this  favorable  effect  of  treatment  is  no  less  evident 
upon  both  maternal  heredity  and  the  mixed  heredity  of 
the  parents.  And  here  you  will  pardon  me  a  short  digres- 
sion, which,  though  separating  us  a  moment  from  our 
■present  line  of  inquiry,  will  shortly  find  its  application. 

Specific  treatment,  I  say,  corrects  v/ith  equal  effective- 
ness the  influence  of  maternal  heredity.  In  proof  of  this, 
innumerable  cases  are  seen  where  syphilitic  women  begin 
by  having  several  abortions,  or  by  bringing  forth  syphilitic 
children ;  then,  after  having  been  submitted  to  a  specific 
medication,  they  bring  forth  at  term  living  and  healthy 
children.  The  cases  of  this  kind  are  so  common  and  so 
numerous,  that  I  think  in  truth  it  would  be  useless  to  stop 
here  for  particular  citations.'^' 

Sometimes,  again,  the  influence  of  treatment  upon  ma- 
ternal heredity  reveals  itself  in  a  much  more  striking 
manner,  on  account  of  the  peculiarities  of  certain  partic- 
ular cases.     Such  is,  for  example,  the  following  case :  A 

*  Example :  A  woman  contracts  syphilis,  and  then  has  eight  miscarriages,  with- 
out being  able  to  carry  an  infant  to  term.  She  submits  herself  to  a  prolonged 
mercurial  treatment,  again  becomes  enceinte,  and  is  delivered  at  term  of  a  well- 
developed  child,  which  is  now  five  years  old,  and  has  never  exhibited  the  slightest 
trace  of  syphilis  (Notta,  memoir  cited). 


IIG   .  SYPHILIS  AND  MARRIAGE. 

young  woman  receives  sypliilis  from  her  first  husband, 
and  is  treated  in  a  very  ephemeral  fashion.  Left  a  vs^idow, 
she  is  married  again  to  a  healthy  man,  and  by  this  hus- 
band conceives  several  children,  that  either  die  in  utero^ 
or  are  born  syphilitic.  She  is  then  treated,  and  after 
treatment  she  brings  forth  only  healthy  children. 

In  the  third  place,  the  influence  of  treatment  upon 
mixed  Jieredity  is  still  more  often  confirmed  in  practice. 

Not  unfrequently  the  following  order  of  events  is  en- 
countered :  Two  syphilitic  parents  begin  by  engendering 
a  succession  of  children,  all  of  which  either  die  before 
birth  or  are  born  syphilitic.  The  parents  are  then  treated. 
Consecutively  to  this  treatment  they  i^rocreate  other  chil- 
dren, which  are  born  at  term,  living  and  healthy. 

One  may  often  trace  in  a  series  of  consecutive  pregnan- 
cies the  progressive  influence  of  treatment  —  when  each 
pregnancy  is  marked  by  a  step  toward  a  cure.  I  have  col- 
lected many  facts  of  this  kind,  among  others  the  following : 

A  young  man  marries,  notwithstanding  a  still  recent 
and  very  negligently  treated  syxDhilis.  His  wife,  almost 
immediately  infected,  aborts  some  months  later.  The  two 
parents  then  commence  to  be  treated  in  earnest.  There 
succeed  four  pregnancies  quite  close  to  one  another,  which 
terminate  as  follows : 

1.  Accouchement  before  term  ;  child  still-born. 

2.  Accouchement  at  term  ;  child  syphilitic,  dying  some 
days  later. 

3.  Accouchement  at  term ;  child  syphilitic,  but  sur- 
viving. 

4.  Accouchement  at  term  ;  child  healthy. 

But  this  is  not  aU ;  and  here  should  be  noted  a  fact  of 
twofold  significance,  which  has  not  been  as  yet,  it  seems 
to  me,  sufficiently  remarked  : 


SUFFICIENT  SPECIFIC  TREATMENT.  117 

1.  It  is  not  necessary,  in  order  tliat  syphilitic  parents 
procreate  healthy  children,  that  the  diathesis  be  annihi- 
lated in  these  parents.  In  other  terms,  and  to  speak  more 
clearly,  it  may  happen  that  the  offspring  of  syphilitic 
parents  may  be  born  healthy,  altJiougJi  tJieir  parents  are 
still  under  the  impress  of  tlie  diathesis^  which  is  proved 
by  the  appearance  of  specific  accidents  npon  them  sub- 
sequent to  the  birth  of  their  children.  This  is  incontest- 
able, so  far  as  relates  to  the  father,  as  we  have  previously 
shown.* 

It  may  be  likewise  demonstrated  as  regards  the  mother. 
As  an  example,  see  one  of  our  present  patients,  in  bed 
]^o.  31,  in  St.  Thomas's  ward.  This  woman  entered  the 
hospital  affected  with  a  sclero-gummatous  glossitis,  the 
origin  of  which  dated  back  three  or  four  months.  Now, 
her  last  child,  aged  fourteen  months,  has  never  presented 
the  least  suspicious  accident ;  it  is  a  very  fine  child,  ab- 
solutely healthy,  as  you  have  been  able  to,  and  may  again, 
convince  yourself  by  sight. 

Likewise,  a  young  woman  among  my  patients,  who 
became  syphilitic  from  contact  with  a  syphilitic  husband, 
has  had  two  children  absolutely  healthy,  although  after 
each  one  of  her  confinements  she  has  been  affected  with 
a  very  intense  eruption  of  squamous  syphilides.f 

*  Yide  page  36,  and  Illustrative  Cases,  Note  I. 

■{■  Here  is  a  summary  of  this  curious  case :  X.,  twenty-two  years  old,  vigorous 
constitution.  At  twenty  years  married  a  man  affected  with  a  recent  syphilis.  First 
pregnancy  in  1868.  Secondary  accidents  toward  the  fifth  month  (erythemato- 
papular  syphilide,  buccal  and  vulvar  syphilides,  alopecia,  cervical  adenopathies). 
Energetic  treatment  with  mercury ;  accouchement  at  term ;  child  healthy ;  con- 
tinues so  ever  since.  Two  months  before  accouchement,  psoriasiform  annular 
syphilide,  occupying  the  lateral  surface  of  the  left  foot.  Ecthyma  of  the  left  leg ; 
mercurial  and  iodide  of  potassium  treatment. 

Second  pregnancy  in  1872;  accouchement  at  term;  child  healthy;  continues 
well  to  this  day.  Three  months  before  accouchement  papulo-squamous,  psoriasi- 
9 


118  SYPHILIS  AND  MARRIAGE. 

2.  In  order  that  a  child  be  born  healthy  of  syphilitic 
parents,  it  may  suffice  that  these  parents  are  being  sub- 
jected to  mercurial  influence  at  the  time  of  its  procreation. 
However  singular,  however  paradoxical,  and,  above  all, 
however  inexjDlicable,  such  a  fact  may  at  first  glance  ap- 
pear, it  would  seem  to  be  evident  from  a  certain  number 
of  well-authenticated  cases.  Such  is,  for  instance,  a  case 
mentioned  by  Turhmann  (de  Schoenfeld),  and  w^hich  is 
briefly  as  follows :  A  syphilitic  woman  first  of  all  has 
seven  pregnancies,  during  which  she  is  not  treated. 
Seven  times  she  gives  birth  to  syphilitic  children,  which 
soon  die.  Becoming  pregnant  an  eighth  and  a  ninth  time, 
she  is  treated  during  the  course  of  these  two  pregnancies, 
and  each  time  she  is  delivered  of  a  sound,  healthy  infant. 
A  tenth  pregnancy  ensues ;  this  time  the  patient  is  not 
treated.  She  is  delivered  of  a  sypJiilUio  child,  which  dies 
at  six  months.  Finally,  an  eleventh  pregnancy,  in  the 
course  of  which  treatment  is  resorted  to,  results  in  a 
TieaMliy  infant.* 

Had  this  case  been  fabricated  out  and  out,  imagined 
theoretically  to  meet  a  necessity,  it  could  not,  in  truth, 
have  been  more  convincing. 

For  my  part,  I  have  already  among  my  notes  certain 
observations  of  the  same  kind  relative  to  syphilitic  par- 
ents who  have  alternately  engendered  healthy  children, 
at  a  time  when  they  were  subjected  preliminarily  to  a 
specific  treatment,  and  syphilitic  children  during  a  period 
when  they  were  not  being  treated,  f 

form,  circinate  sypbilide,  constituting  a  ring  of  large  diameter  upon  the  dorsal 
aspect  of  left  foot.     Resumption  of  treatment ;  cure  of  the  accidents. 

*  Vide  Gazette  Medicale,  June  24,  1843. 

f  The  same  fact  has  been  likewise  remarked  by  M.  Kassowitz  {Die  Vererbung  dcr 
Si/philis,  Vienna,  1876).  Among  a  number  of  observations  testifying  in  the  same 
way,  I  will  cite  the  following,  which  is  accompanied  with  all  possible  guarantees 


SUFFICIENT  8PEGIFIG  TREATMENT.  '  119 

It  would  seem,  then,  from  this,  that  even  the  temporary 
influence  of  treatment  may  sufiice  to  avert  for  the  time 
being  the  effects  of  syphilitic  heredity.  Such,  at  least, 
would  be  the  conclusion  to  be  drawn  from  the  preceding 
cases.  But  I  am  not  willing  to  give  you  this  last  conclu- 
sion as  an  absolutely  demonstrated  fact.  More  prudently, 
I  restrict  myself  to  presenting  it  to  you  as  a  subject  for 
further  study — very  interesting  assuredly,  already  ren- 
dered probable  by  certain  observations  apparently  well 
authenticated,  but  still  lacking  in  a  sufficient  number  of 
guarantees  to  assure  it  the  right  to  be  cited  as  a  scientific 
fact. 

All  the  considerations  which  precede  concur  in  many 
ways  in  establishing  the  modifying,  corrective,  depurative 
influence  which  treatment  exerts  upon  the  diathesis.  And 
the  natural  conclusion  which  results  from  all  this,  as  far 
as  we  are  specially  concerned,  is  that — 

The  essential^  capital  condition  to  he  fulfilled  by 
ewry  sypTiilitic  subject  aspiring  to  marriage  consists 

of  authenticity :  A  young  workman  marries  in  the  third  year  of  a  syphiUs  quite 
vigorously  treated.  His  wife  becomes  enceinte  after  some  months,  and  toward  the 
end  of  the  first  half  of  pregnancy  begins  to  present  symptoms  of  secondary  syphi- 
lis (roseola,  neuralgias,  mucous  syphiUdes,  alopecia,  etc.).  She  is  submitted  to  a 
very  active  treatment,  and  accouches  at  term.  The  infant  is  born  syphilitic,  and 
dies  of  consumption  when  one  month  old.  The  young  wife  continues  to  be  treated 
and  becomes  enceinte  five  months  later.  She  is  delivered  of  a  fine  child,  which, 
very  carefully  observed,  remains  exempt  from  every  suspicious  phenomenon,  and 
is  to-day  in  perfect  health.  Reassured  as  to  the  condition  of  this  woman  by  the 
fact  of  her  giving  birth  to  a  healthy  child,  her  physician  does  not  treat  her  any 
more.  She  becomes  enceinte  a  year  later  and  aborts.  New  pregnancy  some  months 
later ;  another  abortion.  Two  years  later  a  fifth  pregnancy  ensues  ;  birth  at  term, 
of  twin  children,  both  syphilitic. 

Even  supposing  that  the  influence  of  treatment  gives  occasion  for  dispute  in  this 
case,  the  fact  no  less  remains  established,  by  this  and  similar  observations,  that  a 
syphilitic  woman  may  alternately  engender  syphilitic  children  and  healthy  childre7i.  This 
is  an  actual  fact,  which  forces  itself  on  the  conviction,  however  strange  and  para- 
doxical it  may  appear.  It  remains  for  us  to  find  its  explanation ;  but  it  is  only  upon 
the  explanation,  and  not  upon  the  fact  itself,  that  there  can  be  differences  of  opinion. 


120     .  SYPHILIS  AND  MARRIAGE. 

in  a  tliorougTi  specific  treatment.,  in  a  treatment  sufficient 
to  confer  a  complete  immunity  from  tlie  multiple  and 
diverse  dangers  whicTi  syphilis  carries  with  it  in  mar- 
riage. 

In  order  tliat  a  sypMlitic  j)atieiit  may  have  the 
moral  right  to  become  husband,  father,  and  support 
of  a  family,  it  is  necessary,  it  is  indispensable,  that  he 
shall,  by  virtue  of  a  treatment  suflBiciently  protective, 
have  ceased  to  be  dangerous  to  his  wife,  his  children, 
and  himself. 

But  what  is  this  treatment,  ^'■sufficient,  sufficiently 
protective,''''  to  which  we  are  constantly  referring  as  our 
best  safeguard  ? 

This,  gentlemen,  I  have  gone  over  with  you  at  length 
in  a  former  series  of  lectures,  tracing  for  you  in  detail  the 
rules  for  the  treatment  of  syphilis,  such,  at  least,  as  I 
comprehend  them ;  such  as  they  have  been  taught  to  me 
both  by  my  masters  and  by  my  personal  experience.*  At 
present,  then,  I  have  only  to  refer  you  to  these  lectures, 
a  portion  of  which  has  already  been  given  for  publica- 
tion, and  which  you  may  consult  at  leisure.  I  will  limit 
myself  to-day  to  only  reminding  you  in  quite  a  brief 
manner  that  a  treatment  worthy  to  be  characterized  as 
"  sufficient "  is  this  : 

1.  A  treatment  which  is  based  upon  the  administration 
of  the  two  great  remedies  which,  with  just  reason,  are 
commonly  called  the  "specifics  for  the  pox,"  viz.,  mercury 
and  iodide  of  potassium. 

2.  A  treatment  which  is  based  upon  the  administration 
of  these  two  remedies  in  doses  veritably  active  and  cu- 
rative, very  different  from  the  insufficient,  timid,  indiffer- 

*  Du  traiiemcnt  de  la  syphilis  (lectures  delivered  at  tlie  Saint-Louis  Hospital). 
In  press. 


SUFFICIENT  SPEGIFIO  TREATMENT.  121 

ent,  almost  inert,  doses  in  which,  according  to  traditional 
routine,  they  are  most  often  prescribed. 

3.  A  treatment  which  is  prescribed  and  regulated  ac- 
cording to  a  certain  method,  which  has  for  its  aim  and 
result  to  conserve  for  these  remedies,  notwithstanding 
their  prolonged  administration,  their  primitive  intensity 
of  action  (called  the  system  of  intermittent  or  successive 
treatments).'^ 

4.  A  treatment  which,  in  these  conditions,  is  rigorously 
pursued  during  semral  consecutive  years — at  the  mini- 
mum, three  ovfour  years. 

I  especially  insist  upon  the  importance  of  this  last 
point,  and  I  say,  a  chronic  disease^  in  effect,  requires 
chronic  treatment.  Such  is  the  absolute  general  law. 
Long,  very  long,  should  be  the  medication,  if  we  are  not 
content  alone  with  a  present  effect ;  if  we  desire  to  obtain 
a  complete,  thorough,  permanent  cure. 

According  to  experience,  it  is  false,  absolutely  false, 
that  one  has  "finished  with  the  pox"  after  a  treatment  of 
some  months,  of  one  year,  of  two  years  even  (the  extreme 
limit  which  is  scarcely  surpassed  ordinarily).  Treatment 
of  this  kind  furnishes  nothing  more  than  a  provisional 
immunity,  a  temporary  silence  of  the  disease,  leaving  the 
diathesis  in  full  force,  with  all  its  future  dangers,  with  the 

*  Vide  LeQons  sur  la  syphilis  etudiee  plus  particulierement  cliez  la  femme.  Paris, 
1873,  p.  1087,  et  suiv.  A  fact,  of  which  experience  has  absolutely  convinced  me, 
is  that  mercury  and  iodide  of  potassium,  when  administered  for  a  long  time,  and 
without  intermission,  singularly  lose  their  efficacy.  The  continued  use  of  these 
two  remedies,  as  well  as  of  many  others  besides,  creates  a  tolerance  which  enfee- 
bles, lessens,  and  ends  by  annulling  their  therapeutical  effects.  On  this  account  I 
was  forced  to  devise  for  my  patients  a  method  of  treatment  which  should  conserve 
the  full  intensity  of  therapeutic  action  of  both  the  mercury  and  the  iodide  during 
the  entire  duration  of  treatment.  This  method  I  have  exposed  at  length  in  my 
teachings  under  the  name  of  ihe  method  of  successive  or  hitermitteni  tr-eatments.  I 
think  I  am  authorized  jp  saying  that  it  has  been  of  real  service  in  practice,  and  I 
commend  it  to  the  attention  of  my  confreres. 


122  SYPHILIS  AND  MARRIAGE. 

certain  immineiice  of  tertiary  accidents  at  a  subsequent 
period.  Treatment  of  tliis  kind,  I  may  say,  is  to-day  con- 
demned by  its  numerous  deplorable  results.  It  is,  indeed, 
liigli  time  to  renounce,  once  for  all,  these  curtailed  medi- 
cations, to  approacli  tlie  pox  from  tlie  same  therapeutic 
point  of  view  as  we  do  other  constitutional  diseases,  such 
as  scrofula,  gout,  malaria,  etc.,  which  are,  by  common 
consent,  curable  only  by  a  long-protracted  treatment,  only 
by  a  series  of  successive  cures,  only  by  the  repeated,  al- 
most chronic,  intervention  of  the  remedies  appropriate  to 
combat  them. 

For  my  part,  I  consider  myself  authorized  to  assert, 
from  my  own  experience,  that  in  no  case  should  the  dura- 
tion of  an  anti-syphilitic  treatment  fall  below  three  or  four 
years,  with  whatever  form  of  the  disease  we  may  have  to 
do,  however  benignly  the  diathesis  may  have  been  origi- 
nally announced.  Three  or  four  years  methodically  de- 
voted to  an  energetic  medication — such,  in  my  opinion, 
is  the  necessary  minimum,  I  will  not  say  to  cure  the 
disease,  but  to  avert  its  dangerous  manifestations  both 
for  the  present  and  for  the  future. 

Again,  it  is  prudent  that,  after  this  term,  the  patient 
submit  himself  from  time  to  time — every  two  or  three 
years,  for  example — to  a  new  iodide  treatment,  so  as  to 
keep  the  diathesis  incessantly  in  check,  if  I  may  thus  ex- 
press it,  and  to  hold  the  ground  gained.  Combined  with 
time,  the  specific  treatment  of  the  diathesis  constitutes 
certainly  the  hest  guarantee  in  favor  of  the  syphilitic 
subject  who  aspires  to  marriage. 

Time,  on  the  one  hand,  treatment,  on  the  other,  are 
unquestionably  the  two  grand  correctives  of  the  pox,  the 
two  essential  conditions  to  require  of  every  syphilitic  sub- 
ject before  opening  to  him  the  gates  of  marriage. 


CHAPTEE  XI. 

THE  USE   OF   SULPHUE-WATEES. — COlSTCLUSIOl^rS. 

I  cAisr  not  quit  this  subject  of  treatment  mthout  add-  ^ 
ing  some  remarks  relative  to  a  custom  very  fashionable, 
and  considered  by  the  public  as  an  infallible  criterion  of 
the  cure  of  syphilis. 

A  popular  belief,  as  you  know,  ascribes  to  the  sulphur 
mineral  waters  the  singular  property  of  revealing,  of 
"bringing  out,"  the  pox  in  syphilitic  subjects  not  yet 
cured  of  their  disease. 

With  this  object  in  view,  numbers  of  patients  journey 
each  year  to  such  or  such  sulphur  spring,  either  at  their 
own  suggestion  or  by  the  advice  of  their  physicians. 
There  they  religiously  take  the  waters  during  the  tradi- 
tional twenty-one  days,  awaiting,  not  without  anxiety,  the 
result  of  this  treatment.  According  to  their  theory,  "if 
they  have  anything  in  the  blood  the  waters  will  bring  it 
out ;  while,  if  they  are  cured,  if  they  have  nothing,  nothing 
will  come  forth."  In  the  first  alternative,  the  appearance 
upon  the  skin  of  new  syphilitic  symptoms  will  be  an  indi- 
cation that  they  must  undergo  fresh  treatment ;  while,  in 
the  second,  the  absence  of  external  manifestations  will 
constitute  a  pledge  of  cure. 

N"ow,  this  ^^  judgment  of  tlie  waters  "  has  been  applied 
(and  it  could  not  fail  to  be)  to  the  serious  question  of  mar- 


124  S7PEILIS  Ayn  MARRIAGE. 

riage.  You  will  find  this  opinion  entertained  by  numbers 
of  your  patients,  that,  before  thinking  of  taking  a  wife,  it 
is  the  duty  of  every  syphilitic  subject  to  make  a  pilgi^im- 
age  to  some  sulphur  spring,  in  order  to  ascertain  what 
pertains  to  his  specific  state  in  general,  and  his  matrimo- 
nial fitness  in  particular. 

Now — have  I  need  to  say  it  ? — this  pretended  revealing 
action  of  the  suli)hur- waters  is  far  from  being  what  it  is 
gratuitously  sup^Dosed  to  be.  It  is  very  far  from  the  truth 
that  it  ^^  unveils  the  un^nown,^^  following  the  classic  ex- 
pression, and  that  it  furnishes  a  sort  of  criterion  of  the 
cure  of  syphilis. 

Without  doubt,  sulphur- waters  may  determine  specific 
eruptions  in  syphilitic  subjects  in  some  cases  ;  and  it  could 
not  well  be  otherwise,  considering  the  excitant,  irritant 
action  which  they  exert  upon  the  skin,  especially  when 
used  daily  in  the  form  of  baths,  douches,  vapor-baths,  etc., 
as  is  the  case  in  the  great  majority  of  our  bathing  stations. 
All  hydropathic  physicians  have  observed  and  reported 
cases  of  this  kind,  and  I  could  myself  relate  several 
examples. 

But  this  action  of  the  waters,  we  must  remark,  is  not 
constant ;  and  here  is  the  proof :  In  the  first  place,  num- 
bers of  syphilitic  patients  are  sent  each  year  to  sulphur 
stations  from  divers  motives.  Even  when  they  are  sup- 
posed to  be  by  no  means  cured  they  are  sent  there,  for 
example,  in  order  to  be  built  up,  in  order  "to  recruit  both 
from  their  disease  and  from  the  effects  of  treatment." 
But  we  observe  that  they  almost  all  return  from  these 
thermal  stations  without  having  experienced  the  least  new 
manifestation  upon  the  skin,  mthout  having  perceived  the 
least  cutaneous  awakening  of  the  diathesis.  On  the  other 
hand,  we  have  now  the  experience  of  these  so-called  reveal- 


TEE  USE  OF  SULPEUR-WATEES.  125 

ing  cures,  and  we  know  what  they  are  worth.  I  have  in 
my  notes  hundreds  of  observations  relating  to  patients 
who  have  taken  one,  two,  three,  and  up  to  six  courses  of 
sulphur- waters  without  having  had  any  eruption  produced 
upon  them,  and  who  afterward,  at  quite  distant  intervals, 
have  suffered  from  several  severe  assaults  of  the  disease. 
Within  a  few  days,  for  example,  I  have  been  called  to 
treat  a  man  stiU  young,  presenting  undoubted  symptoms 
of  cerebral  syphilis.  ITow,  this  patient,  like  so  many 
others,  had  gone  to  Luchon  before  his  marriage,  and 
on  account,  even,  of  his  projected  marriage.  He  had 
been  there  three  seasons,  and  nothing  had  been  mani- 
fested upon  him.  After  such  assurance,  it  was  thought 
that  he  might  be  allowed  to  marry  without  apprehen- 
sion. The  result  has  shown  the  justness  of  the  prog- 
nosis ! 

A  similar  result  has  occurred  likewise  in  many  and 
many  other  cases  which  I  could  cite,  and  of  which  every 
physician  could  enlarge  the  list. 

The  revealing  action  of  the  sulphur- waters  constitutes, 
then,  in  no  respect  a  criterion  which  can  be  relied  upon. 
The  test  of  the  waters  is  a  legend  to  be  abandoned  like  so 
many  others.  It  is  false,  absolutely  false,  that  the  sulphur- 
waters  "disengage"  the  pox  from  the  organism  in  the 
manner  of  a  reagent,  w^hich  disengages  a  body  from  a 
chemical  combination.  And,  clinically,  we  can  expect  no 
solid  guarantee  from  a  thermal  treatment  in  order  to  de- 
termine the  question  of  the  cure  of  our  patients  who  are 
contemplating  marriage. 

For  one  time  that  this  revealing  action  takes  place,  it 
will  fail  twenty  times,  fifty  times,  perhaps.  "What  security 
can  a  process  so  subject  to  failure  furnish  ?  What  would 
be  thought  in  chemistry,  for  example,  of  a  reagent  which, 


126  SYPHILIS  AND  MARRIAGE. 

nineteen  times  out  of  twenty,  did  not  disclose  tlie  special 
body  wMch  it  was  intended  to  reveal  ? 

And  let  no  one  accuse  me  of  making  a  war  of  prejudice 
against  sulphur- waters.  The  accusation  would  fall  to  the 
ground,  as  I  am  "a  believer"  in  sulphur- waters — I  pre- 
scribe them  frequently,  quite  frequently,  in  the  course  of 
syphilis,  and  every  year  I  send  numerous  patients  to  our 
stations  in  the  Alps  and  the  Pyrenees.  But  I  believe  in 
these  waters,  and  I  prescribe  them,  for  other  indications 
than  that  of  their  pretended  revealing  property.  I  believe 
in  their  utility  as  tonic,  renovating  agents,  especially  in 
cases  of  syphilis  of  the  asthenic  form,  or  of  syphilis  com- 
plicated with  lymphatism,  scrofula,  etc.  I  believe  also 
that  they  may  render  incontestable  service  in  facilitating 
the  tolerance  of  strong  mercurial  medication  in  those  cases 
where  there  is  occasion  to  require  of  mercury  its  full  in- 
tensity of  action.  I  do  not  deny  that  they  may  sometimes 
come  in  as  an  aid  to  diagnosis,  in  determining  cutaneous 
manifestations  ujoon  our  patients  which  could  not  be  pro- 
duced without  them.  That  only  which  I  deny,  which  I 
energetically  repel  as  a  dangerous  error,  is  their  pretended 
faculty  of  arbitration  in  questions  so  grave  as  these — the 
cure  or  the  non-cure  of  the  pox — the  fitness  or  the  un- 
fitness of  a  syphilitic  subject  for  marriage. 

I  have  just  passed  in  review  before  you,  gentlemen,  the 
several  conditions  which,  in  my  opinion,  a  syphilitic  subject 
should  satisfy  in  order  to  justify  him  in  aspiring  to  marriage. 

From  the  foregoing,  you  have  already  deduced  these 
natural  conclusions : 

1.  To  every  patient  not  fulfilling  the  conditions — all  the 
conditions  of  this  programme — I  believe  that  the  physician 
ought  expressly  and  energetically  to  interdict  marriage. 


CONCLUSIONS.  127 

3.  To  every  patient  satisfying  fully  and  completely  all 
these  conditions,  I  believe  tliat  the  physician  may  safely 
permit  marriage.*  This,  in  effect,  is  only  the  necessary 
deduction  from  the  premises  which  we  have  established. 
It  is  the  application  of  them,  pure  and  simple. 

However,  after  having  traced  and  defined  for  you  this 
programme  of  admissibility  to  marriage,  such  as  I  under- 
stand it,  I  should  like  to  add  a  few  reflections,  a  few  com- 
ments which  appear  to  me  indispensable. 

In  the  first  place,  take  this  programme  only  for  what 
it  is  and  what  it  is  worth.  It  is  not  a  programme  received, 
discussed,  and  accepted  by  contemporary  science.  It  is 
purely  and  simjoly  the  condensed  result  of  my  personal 
observation,  aided  by  certain  contributions  which  I  have 
been  able  to  gather  here  and  there  from  diverse  sources. 

It  is,  in  the  second  place,  a  programme  subject  to  re- 
visions, susceptible  of  amendments,  additions,  and  correc- 
tions, and  which  I  shall  be  the  first  to  modify  as  soon  as 
further  observations  shall  point  out  the  changes  to  be  in- 

*  I  regard  it  as  superfluous  to  speak  here  of  the  various  recommendations  with 
which  the  physician  should  accompany  his  acquiescence  in  the  marriage  of  a  syph- 
ilitic subject,  and  which  are  quite  naturally  suggested  by  the  preceding  considera- 
tions. Of  these  recommendations,  the  principal  and  most  indispensable  one  is  that 
which  relates  to  the  minute  and  careful  watch  which  the  future  husband  should 
exercise  over  his  own  person,  so  as  to  allow  nothing  to  pass  unperceived  which 
could  give  rise  to  an  offensive  return  of  the  diathesis.  It  is  very  essential  that 
we  should  warn  our  patients  of  the  possible  dangers  of  every  lesion  which  mani- 
fests itself  upon  them,  however  minute  and  however  insignificant  it  may  appear  to 
be.  It  is  very  essential  that  they  receive  from  us  the  explicit  injunction  to  refrain 
from  all  relations,  from  every  contact,  in  case  they  should  be  affected  with  any 
lesion  whatever,  either  of  the  genital  organs  or  of  the  mouth,  the  throat,  etc.  How 
often  have  I  heard  such  or  such  a  patient,  who  had  had  the  misfortune  to  infect 
his  wife,  bitterly  censure  his  physician  because  he  had  not  sufSciently  enlightened 
him  upon  the  dangers  of  contagion  !  It  is  always  the  same  complaint  which  hus- 
bands repeat  to  us  in  these  unfortimate  situations  :  "  I  was  not  forewarned.  If  I 
had  known  what  I  have  since  learned  to  my  cost,  I  should  never  have  communi- 
cated the  disease  to  my  wife,"  etc.  Let  us  be  warned  in  our  turn,  and  not  risk  the 
possibility  of  such  a  reproach. 


128  S7PEILI8  AND  MARRIAGE. 

troduced,  and  certain  points  of  the  question,  still  obscure 
and  inexplicable  for  me,  shall  have  been  elucidated.* 

Besides,  gentlemen,  do  not  delude  yourselves  with  the 
possibility  of  ever  constituting  that  which  I  would  call 
(permit  me  the  phrase)  a  perfect  code  of  marriage,  for  the 
use  of  sypliiUtic  subjects — that  is  to  say,  of  building  up  a 
programme  which  shall  respond  to  all  possible  contingen- 
cies, which,  in  a  manner  absolutely  certain,  shall  deter- 
mine in  all  cases  the  fitness  or  the  unfitness  for  marriage 
of  a  patient  tainted  with  syphilis.  A  categorical  solution 
of  a  problem  of  this  kind,  a  solution  stamped  with  mathe- 


*  To  speak  only  of  one  of  these  points,  which  I  can  not  explain,  and  which  is 
to  me  a  source  of  perpetual  astonishment,  viz.,  that  certain  cases  of  syphilis  show 
themselves  so  dangerous,  so  pernicious,  and  certain  others  so  benign,  so  inoffensive, 
as  regards  their  consequences  in  marriage.  I  have  in  hand  certain  observations 
relative  to  patients  who  have  married  in  spite  of  a  severe  and  insufficiently  treated 
syphilis,  and  have,  nevertheless,  remained  inoffensive  both  for  their  wives  and  for 
their  children.  Such  is  the  history  of  one  of  my  patients  who  married  in  spite  of 
me,  when  scarcely  cured  of  a  guttural  phagedena  of  the  most  menacing  character. 
Such  is  the  case  of  another  patient  who,  without  consulting  me,  contracted  marriage 
when  scarcely  cured  of  multiple  accidents  of  a  malignant  syphilis  (profound  ecthy- 
ma, rupia,  cephalalgia,  hemiplegia,  etc.).  Now,  these  two  imprudent  syphilitics, 
contrary  to  all  rational  previsions,  have  had  healthy  children,  and  their  wives  have 
remained  uncontaminated.  Conversely,  we  sometimes  see  patients  who,  although 
having  been  affected  with  only  an  average  or  benign  type  of  syphilis,  and  treated 
for  a  more  or  less  protracted  time,  after  conscientiously  waiting  several  years  be- 
fore contracting  marriage,  have,  nevertheless,  procreated  syphilitic  children,  and, 
in  one  way  or  another,  infected  their  wives.  As  an  example,  I  will  cite  the  case 
of  one  of  my  present  patients.  In  1864  he  contracted  syphilis,  which  manifested 
itself  by  slight  accidents  (mucous  patches  of  the  throat,  crusts  of  the  hairy  scalp, 
temporary  falling  out  of  the  hair,  etc.).  lie  was  treated  during  two  or  three  years. 
Having  been  exempt  from  every  suspicious  symptom  for  about  five  years,  in  1871 
he  thought  that  he  might  marry — not,  however,  without  having  taken  the  advice  of 
one  of  our  eminent  confrercn  upon  this  subject.  And  then  he  procreated  a  syphi- 
litic infant,  which  communicated  the  syphilis  to  its  mother  in  ufcro  !  What  con- 
trast, what  disparity  between  these  two  orders  of  cases !  Both,  assuredly,  have 
their  raisons  d'etre^  their  material,  organic  explanation.  But  we  are  forced  to  con- 
fess that  in  the  present  state  of  our  knowledge  this  explanation  absolutely  baffles 
us.  There  is,  assuredly,  an  unknown  quantity  which  eludes  us,  at  least  for  the 
present,  and  doubtless  numerous  observations  will  yet  be  necessary  to  disengage 
it  from  the  multiple  elements  of  so  complex  a  problem. 


GONGLUSIONS:  129 

matical  precision,  is  not,  and  never  will  be,  possible.  To 
even  liope  for  it  would  be  evidence  of  a  non-professional 
understanding. 

Always,  whatever  we  may  do,  our  verdict  will  be  based 
upon  a  simi)le  calculation  of  probabilities — tliat  is  to  say, 
upon  an  appreciation,  essentially  difficult  and  delicate,  of 
vague  and  ill-defined  elements,  such  as,  on  the  one  hand, 
the  previsional  diagnosis  of  a  diathesis,  and,  on  the  other 
hand,  the  degree  of  corrective,  preventive  influence  ex- 
erted upon  this  diathesis  by  treatment.  Consequently, 
we  should  not  conceal  it  from  ourselves,  nor,  for  that  mat- 
ter, from  our  patients,  that  our  decision  can  only  have  a 
degree  of  certainty  proportionate  to  the  elements  which 
serve  as  its  basis.  That  is  to  say,  whatever  the  attention, 
whatever  the  painstaking  care  we  may  bring  to  the  ex- 
amination of  a  particular  case,  it  is  not  impossible  that 
the  results  may  baffle  our  expectations ;  it  is  not  impos- 
sible that  we  may  fall  into  an  error.  For,  I  repeat  the 
expression  by  design,  we  rely  upon,  and  we  can  only  rely 
upon,    "a  calculation  of  probabilities"  in  forming  our 

opinion. 

And  yet,  gentlemen,  do  not  get  a  wrong  impression 

from  this  last  sentence.  Because  a  mathematical  cer- 
tainty fails  us  in  this  matter,  it  does  not  follow — far  from 
it — that  the  physician  may  not  be  competent  to  render  to 
patients  and  to  society  frequent  and  inestimable  services 
in  this  grave  matter  of  the  marriage  of  syphilitic  subjects. 
Consider,  for  a  moment,  how  these  things  present  them- 
selves, and  appreciate  exactly  the  situation  as  it  occurs  in 
practice. 

A  patient  consults  his  physician  in  order  to  know  if  he 
may  or  may  not  marry,  notwithstanding  an  anterior  syphi- 
lis.    The  physician  interrogates  and  examines  this  patient, 


130    .  SYPHILIS  AND  MARRIAGE. 

searches  out  tlie  conditions  favorable  or  unfavorable  for 
marriage — in  a  word,  prepares  a  balance-sheet  of  the  case, 
and  endeavors  to  form  an  oj)inion.  One  of  tAvo  things 
then  happens,  viz.  :  either  the  physician  will  have  gathered 
from  this  examination  facts  sufficient  to  satisfy  him  as  to 
the  condition  of  his  patient,  and  enable  him  to  pronounce 
an  opinion  in  one  way  or  the  other  (and,  in  this  case,  there 
are  but  few  risks  that  his  Judgment  will  be  discredited  by 
the  results) ;  or,  indeed,  he  will  fail  to  find  the  necessary 
elements  upon  which  to  found  his  opinion,  to  satisfy  his 
Judgment.  In  this  second  alternative,  he  will  refrain  from 
announcing  a  verdict.  For,  be  it  understood,  the  physi- 
cian is  not  bound  even  to  have  an  opinion  ;  he  is  not  in 
the  position  of  a  Judge  who,  from  his  hie;h  tribunal,  is 
under  obligation  to  decide,  to  pronounce  Judgment  be- 
tween two  adverse  parties.  On  the  contrary,  he  has  the 
opportunity  of  excusing  himself,  of  appealing  to  the  fu- 
ture, and  of  saying  to  his  patient:  "Under  the  present 
conditions  it  is  impossible  to  know  how  to  act  in  your 
position.  You  might  perhaps  still  be  dangerous  in  mar- 
riage. For  the  present,  then,  we  will  not  come  to  a  de- 
cision ;  it  is  necessary  for  you  to  wait.'''' 

Such  is  the  situation,  and  not  otherwise  :  please  remark 
it,  for  one  is  too  apt  to  forget  it.  And,  I  again  repeat,  the 
physician  is  not  obliged  to  fall  either  into  an  error,  or  to 
risk  a  hazardous  Judgment,  when  he  has  not  the  elements 
necessary  for  the  solution  of  the  problem  before  him.  It 
is  by  remaining  faithful  to  this  rule  of  conduct,  by  abiding 
within  these  limits,  within  this  boundary,  that  the  physi- 
cian -will  respect  science,  and  will  most  effectively  serve 
the  interests  of  his  patient. 

I  have  often  seen  patients  marry  against  the  advice 
and  express  prohibition  of  their  physician.     And,  upon 


CONCLUSIONS.  131 

consulting  either  my  recollections  or  my  written  notes,  I 
find  this  :  that  if  some  few  of  these  imprudent  individuals 
have  not  had  cause  to  repent  of  their  rashness,  yet  a  very 
large  number  of  them  (I  may  even  say  an  enormous  ma- 
jority) have  experienced  the  most  lamentable  catastrophes, 
either  by  introducing  the  pox  into  their  homes,  or  in  pro- 
creating children  syphilitic  or  puny,  and  almost  always 
doomed  to  an  early  death ;  *  or,  finally,  in  paying  their 
personal  debt  to  syphilis  to  the  great  detriment  of  their 
family. 

On  the  other  hand,  also,  I  have  seen  patients  marry 
after  a  medical  examination,  and  with  the  consent  of 
their  physician.  And  here,  again,  the  same  proportion 
was  met  with  in  the  results,  but  in  a  directly  opposite 
sense.  Save  certain  very  rare,  really  exceptional  cases, 
where  the  anticipations  of  the  physician  were  negatived 
by  the  developments,  the  almost  absolute  rule  was  that 
these  patients  were  not  dangerous  subsequently,  either  to 
their  wives,  to  their  children,  or  to  themselves. 

*  I  have  just  observed  a  case  which  well  merits,  by  way  of  example,  to  be  re- 
corded here :  A  young  man  contracts  the  syphilis.  At  its  outset  he  only  expe- 
riences slight  accidents — roseola,  erosive  syphilides  of  the  mouth,  crusts  of  the 
hairy  scalp,  cervical  adenopathies,  etc.  He  is  treated  with  mercury  during  several 
months.  Everything  disappears,  and  he  considers  himself  cured.  About  six 
months  later  he  marries,  in  sjnte  of  the  explicit  prohibition  of  his  physician.  His 
young  wife  becomes  enceinte  almost  immediately.  Toward  the  fourth  month  of 
her  pregnancy  she  begins  to  present  unmistakable  signs  of  secondary  syphilis 
(erythemato-papular  syphilide,  vulvar  and  buccal  syphilides,  iritis,  cephalalgia, 
lumbago,  neuralgias,  sleeplessness,  nervous  accidents,  etc.).  She  aborts  at  the 
sixth  month.  The  following  year  two  other  pregnancies  ensue — abortion  at  fifth 
month ;  accouchement  almost  at  term  of  a  syphilitic  infant,  which  succumbs  in 
twenty-four  hours.  Fifteen  months  afterward,  fourth  pregnancy :  accouchement  at 
eight  months  of  a  still-born  infant.  Treatment  always  irregularly  followed  by  the 
liusband  and  by  the  wife.  Ten  years  later,  the  husband  is  attacked  with  cerebral 
accidents,  which,  by  common  consent  of  several  other  physicians  and  myself,  are 
referred  to  a  specific  encephalopathy.  Tardily  administered,  the  anti-diathetic 
treatment  only  succeeds  in  temporarily  suppressing  the  accidents,  and  the  patient 
is  rapidly  carried  off. 


132  SYPHILIS  AND  MARRIAGE. 

The  marriages  contracted  under  these  conditions  have 
almost  invariably  terminated  in  happy  results.  This  I 
'am  in  a  position  to  vouch  for,  figures  in  hand.  Is  it 
enough  to  say,  then,  that  the  judgment  of  an  intelligent 
and  prudent  physician  affords  in  this  matter,  even  from 
this  "calculation  of  probabilities,"  substantial  guaran- 
tees ? 

Is  it  enough  to  say,  finally — and  I  do  not  revert  with- 
out satisfaction  to  this  last  point — that  the  physician  con- 
sulted upon  the  question  of  the  marriage  of  a  syphilitic 
patient  renders  a  most  important  and  valuable  service  by 
protecting,  in  this  solemn  moment,  on  the  one  hand,  the 
interests  of  his  patient,  and,  on  the  other  hand,  behind 
this  patient,  the  interests  of  society  ? 


PAET    II. 
AFTER     MARRIAGE. 


CHAPTEE    XII. 

HUSBAND   SYPHILITIC   AND   WIFE  HEALTHY. 

We  are  about,  gentlemen,  to  continue  and  complete 
our  study  of  the  relations  of  syphilis  witli  marriage. 

Hitherto  we  have  considered  the  question  only  defore 
marriage.  It  now  remains  for  us  to  study  it  after  mar- 
riage. 

The  evil  which  we  desired  to  prevent  is  accomplished. 
A  syphilitic  man,  not  cured  of  his  syphilis,  has  been 
married.     He  is  a  husband. 

What  dangers  may  result  from  this  situation  ?  And 
what  role  have  we  to  play,  medically,  in  order  to  avert  or 
lessen  these  dangers?  Such  is  the  question  which  it  is 
now  necessary  for  us  to  approach. 

A  practical  question,  if  there  ever  was  one  ;  a  ques- 
tion teeming,  as  you  m^II  see  but  too  well  in  the  course  of 
this  exposition,  with  embarrassments  and  difficulties  of 
many  kinds,  with  situations  equivocal,  delicate,  complex, 
etc.  ;  a  question  seldom  to  be  met  mth  in  the  hospital, 
but  of  frequent  occurrence  in  private  practice,  where  it 
forces  itself  upon  the  physician's  attention.     Consequent- 

10 


134  SYPEILIS  AND  MARRIAGE. 

ly,  I  have  thouglit  it  would  be  useful  to  discuss  it  before 
you  in  detail,  in  order  to  spare  you  an  apprenticesliip, 
always  more  or  less  painful  to  undergo,  in  personal  ex- 
perience. 

The  evil  is  consummated,  I  said.  A  syphilitic  man, 
although  not  cured,  is  married,  and  is  now  a  husband, 
with  a  syphilis  in  full  vigor,  in  full  activity  of  manifesta- 
tion. A  dejplorable  situation,  by  no  means  uncommon, 
from  various  causes.  It  may  be  that  the  patient  (as  is 
most  commonly  the  case),  believing  himself  cured,  incon- 
siderately contracts  a  premature  marriage  ;  it  may  be  that, 
consciously  and  voluntarily,  he  braves  the  dangers  of  such 
a  position  ;  or,  it  may  be  that,  ignorant  of  his  real  disease, 
he  mistakes  the  nature  of  the  lesions  Avith  which  he  was 
affected  before  his  marriage.  And,  if  you  will,  we  shall 
place  side  by  side  with  facts  of  this  kind  two  other  classes 
of  cases  which,  though  very  different  from  the  first,  as 
regards  the  chronological  order  of  the  accidents,  are  no 
less  liable  to  terminate  in  a  situation  exactly  identical, 
viz.  : 

1.  The  cases  (very  numerous  these  are)  in  which  a 
married  man  contracts  syphilis  after  his  marriage  in  an 
extra-conjugal  adventure,  or  rather  misadventure. 

2.  The  cases  (infinitely  more  rare,  really  exceptional) 
where  syphilis  breaks  out  upon  a  man  quite  recently  mar- 
ried, from  the  fact  of  a  contagion  to  which  he  was  exposed 
some  days  before  marriage.  I  will  explain  by  an  example 
borrowed  from  my  notes  : 

A  young  man,  of  high  social  position,  has  connection, 
eleven  days  before  his  marriage,  with  one  of  his  former 
mistresses,  who  is  affected  at  the  time  (as  is  afterward 
demonstrated)  with  mucous  patches  of  the  vulva.  He 
marries  absolutely  healthy  in  appearance.     Eight  days 


HUSBAND  87PEILITI0  AND    WIFE  EEALTEY.       135 

after  his  nuptials  lie  notices  a  slight  redness  upon  the 
glans,  which  soon  degenerates  into  a  typical  indurated 
chancre,  the  beginning  of  a  constitutional  syphilis,  which 
he  soon  transmits  to  his  young  wife.* 

Whatever  be  the  chronological  origin  of  syphilis, 
whether  the  contagion  be  anterior  or  posterior  to  mar- 
riage, the  situation,  I  repeat,  is  absolutely  the  same  in 
these  diverse  cases.  We  always  find  the  same  scene  re- 
curring with  the  same  personages,  viz.,  on  the  one  hand, 
a  healthy  woman;  on  the  other,  a  syphilitic  husband. 
These  conditions  existing,  what  will  take  place?  What 
will  take  place,  first  of  all,  is  that  this  husband,  on  the 
first  invasion  of  a  suspicious  phenomenon,  will  rush  into 
the  office  of  a  physician,  and,  burning  with  excitement 
and  anxiety,  will  address  him  in  the  following  language 
(which  I  reproduce  from  reality,  you  may  believe  me): 
"Doctor,  save  me  !  I  believe  I  have  symptoms  of  syphi- 
lis. Now,  /  amn  married.  Just  consider  a  moment  my 
situation,  if  I  were  to  give  the  pox  to  my  wife — ^if  I  were 
to  have  syphilitic  children  !  Preserve  me  from  this,  I  beg 
of  you,  and  explain  to  me  everything  I  should  do  in  order 
to  guard  against  such  dangers." 

Consulted  under  such  circumstances  (and  you  will  often 
be,  I  assure  you),  what  will  you  reply  ? 

In  my  opinion,  your  professional  role  is  all  traced  out ; 
and,  if  you  will  be  advised  by  me,  your  reply  will  be  the 
following : 

"I  see  three  orders  of  dangers  in  the  situation  for 
which  you  do  me  the  honor  to  seek  my  advice,  viz.  : 

"1.  Your  own  personal  dangers,  those  which  may  re- 
sult to  yourself  from  your  disease. 

*  Cases  of  this  kind  are  extremely  important  to  know  in  practice.     I  have 
called  the  attention  of  my  readers  to  them  (vide  "  Illustrative  Cases,"  Note  IV). 


136  .  SYPHILIS  AND  MARRIAGE. 

"  2.  A  danger  of  contagion  for  your  wife. 

"  3.  A  danger  of  heredity  for  your  future  children. 

"Now,  it  is  not  only  necessary  that  we  should  guard 
against  these  three  orders  of  dangers  ;  it  is  necessary,  too, 
for  us  to  attend  to  them  all  in  an  equal  measure ;  for  you 
would  be  culpable,  and  I  should  be  culpable  with  you,  if 
we  aimed  only  at  your  individual  security,  without  taking 
precautions  for  your  wife  and  your  children.  In  conse- 
quence, it  is  a  triple  consultation  that  I  have  to  give  you. 

"And,  first,  let  us  consider  the  most  urgent  indication. 
Let  us  speak  of  yourself.     That  will  be  my  first  step. 

"As  to  you,  sir,  you  must  be  treated  in  the  most  ener- 
getic manner,  and  everything  be  done  in  order  to  cure 
you  at  the  earliest  possible  moment.  For  it  is  from  you, 
in  brief,  that  all  the  consequences  proceed  which  may  fall 
upon  others. 

"To  this  end,  here  is  my  advice,"  etc. 

But,  before  going  further  in  this  scene,  what  are  you 
about  to  advise  this  patient  to  do — this  syphilitic  present- 
ing himself  to  you  under  these  special  conditions  ? 

Certainly,  as  regards  the  nature  and  the  character  of 
the  remedies,  you  will  prescribe  for  him  what  you  would 
prescribe  for  any  one  else,  for  there  are  not,  that  I  am 
aware  of,  any  special  remedies  for  the  particular  use  of 
syphilitic  husbands. 

But  as  regards  intensity,  as  regards  vigor  of  medica- 
tion, it  is  an  altogether  different  affair,  in  my  estimation. 
Bear  in  mind  that  you  are  in  the  presence  of  a  husband, 
of  a  husband  living  in  contact  with  a  young  wife,  liable 
to  infect  this  wife  in  the  thousand  intimacies  of  domestic 
life,  without  even  speaking  of  sexual  relations,  from  which, 
it  is  to  be  feared  that,  notwithstanding  all  your  warnings, 
your  patient  will  not  abstain.     I  will  add  to  this  last  state- 


EUSBAFD  SYPHILITIC  AND    WIFE  HEALTHY.       137 

ment — and  it  is  well  to  know  it  in  practice — that  in  such 
cases  your  patient  will  show  himself  much  less  tractable 
to  your  prescription  of  continence,  as  he  has  an  interest 
in  concealing  his  condition,  and  is  not  willing,  as  he  will 
tell  you,  "that  his  wife  should  divine  his  disease,"  etc. 
Be  less  sure  of  him  in  this  particular  than  you  would  be 
of  any  other  patient  in  a  diiferent  situation.* 

Now,  from  these  special  conditions  are  practically  de- 
rived special  indications,  of  which  you  will  comprehend 
in  advance  both  the  object  and  the  useful  results. 

These  indications,  even  speaking  of  the  principal  ones 
only,  are  briefly  as  follows : 

I.  In  the  first  place,  to  suppress  forthwith  the  sources 
of  contagion,  and  to  suppress  them  by  a  cauterization  at 
once  sufficient  and  energetically  corrective. 

If,  for  instance,  the  case  be  one  (by  far  the  most  com- 
mon) of  secondary  accidents  of  the  mouth,  of  the  throat, 
or  of  the  penis,  etc.,  destroy  them  immediately  by  a  vigor- 
ous cauterization.  As  for  the  nitrate  of  silver,  a  feeble 
caustic,  there  might  be  risk  of  its  proving  insufficient; 
choose,  in  preference,  the  acid  nitrate  of  mercury,  a  more 
active  caustic,  and  much  more  certain  as  regards  effects. 

Should  this  cauterization  not  succeed  in  correcting  im- 
mediately, in  situ,  the  contagious  nature  of  these  acci- 
dents, it  vdn  at  least  certainly  provoke  their  cicatrization 
in  a  short  time  ;  and  this  is  what  we  desire. 

*  I  have  known  syphilitic  hiisbands  to  not  dare  abstain  from  intercourse  with 
their  wives  during  a  period  when  the  contagion  was  transmissible,  from  the  fear 
that  a  suspension  of  habitual  relations  might  give  a  hint  as  to  their  disease.  In 
order  to  avoid  suspicion,  they  risk  transmitting  the  pox  to  their  wives  !  The  fact 
is  scarcely  credible,  but  it  is  none  the  less  authentic,  nevertheless.  It  is  authentic 
to  the  extent  that  two  of  my  patients,  in  conditions  of  this  kind,  have,  in  endeavor- 
ing to  prcveiit  suspicion,  ended  by  infecting  their  wives.  Facts  of  this  kind  ought 
to  be  signalized,  for  one  would  not  imagine  them  a  priori,  one  would  not  suppose 
them  possible,  without  having  had  peremptory  proofs  from  personal  observation. 


138  SYPHILIS  AND  MARRIAGE. 

It  is  superfluous  to  add  that  tlie  cauterization  should 
be  immediately  followed  up  by  the  employment  of  such 
topical  applications  as  are  best  adapted  to  promote  the 
speedy  cure  of  those  centers  of  contagion. 

II.  To  cut  sliort,  hy  a  medication  of  especial  intensity, 
the  contagious  accidents  of  the  secondary  stage. 

Under  ordinary  circumstances,  when  called  upon  to 
treat  syphilis,  the  medication  which  we  usually  prescribe 
to  patients  is  at  once  mild,  guarded,  cautious,  careful,  our 
endeavor  being  to  adapt  it  to  individual  tolerance.  We 
go  slowly,  gently,  patiently,  for  we  have  time  before  us ; 
and  proceed  with  moderation,  even  allowing  the  diathesis 
to  get  the  upper  hand  from  time  to  time  in  temporary 
outbursts.  But,  under  the  special  circumstances  now 
under  consideration,  the  case  is  different.  It  is  urgent 
here  to  avert  the  imminent  dangers  of  contagion.  With 
this  view,  the  indication  is  to  malce  haste  and  to  striJce  hard, 
if  I  may  thus  speak,  in  order  to  silence  all  menacing  mani- 
festations— menacing,  be  it  well  understood,  not  for  the 
patient,  but  for  his  wife,  whom  it  is  necessary  to  protect. 

So,  then,  in  place  of  the  usual  medication,  in  place  of 
the  traditional  "five  centigrammes"  of  proto-iodide,  I  be- 
lieve that  there  is  every  advantage  in  instituting  from  the 
outset  an  energetic  repressive  treatment.  I  believe  that 
we'  should  act  in  this  emergency  as  we  act  when  in  pres- 
ence of  grave  specific  accidents  which  it  is  important  to 
suppress  promptly.  In  a  word,  I  am  here  in  favor  of  a 
swift  and  violent  treatment,  yet  avoiding  extremes,  and 
without  running  the  risk,  in  going  too  fast,  of  being 
forced  to  go  backward — I  mean  forced  to  suspend  the 
medication.  With  this  intention,  prescribe,  then,  from 
the  very  first,  strong  mercurial  doses.  Ten  to  fifteen 
centigrammes  of  the  proto-iodide,  two  or  three,  and  even 


HUSBAND  SYPHILITIC  AND   WIFE  HEALTHY.       139 

four,  centigrammes  of  the  sublimate,  daily,  would  not 
constitute  an  excessive  average,  at  least  in  general,  ex- 
ception made  for  individual  tolerance,  which,  is  always  to 
be  taken  into  account.  Often,  even,  it  will  not  be  inju- 
dicious to  associate  the  iodide  with  the  mercury,  in  order 
to  render  the  medication  still  more  active.  Pursue  this 
treatment  about  two  months,  then  discontinue  it  for  some 
weeks,  in  order  to  avoid  the  effects  of  habituation,  be- 
ginning again  afterward  in  the  same  way,  for  the  same 
time,  and  so  on  successively."^ 

Proceeding  in  this  manner,  you  will  often,  if  not  al- 
ways, succeed  in  suppressing  all  or  a  part  of  the  second- 
ary manifestations  ;  you  will  succeed  notably — and  this 
is  the  object  you  have  in  view — in  diminishing  the  num- 
ber and  intensity,  even  perhaps  in  averting  completely, 
the  crops  of  eruption  upon  the  mucous  surfaces,  which, 
under  the  name  of  mucous  patches,  are  so  formidable  as 
regards  contagion,  and  constitute  the  common,  habitual 
source  of  contamination  in  marriage. 

Without  doubt,  this  desperate  treatment  will  not  al- 
ways be  to  your  patient's  taste.  Without  doubt,  it  will 
cause  a  certain  degree  of  disturbance,  it  may  be,  of  his 
gums,  it  may  be  of  his  digestive  functions.  But,  with  a 
careful  supervision,  with  moderation  and  caution  in  your 
vigor,  you  will  almost  always  succeed  in  accustoming  him 
to  accept  and  tolerate  this  plan  of  treatment,  f 

*  I  do  not  speak  here  of  mercurial  frictions,  and  for  cause.  Frictions  certainly 
constitute  an  excellent  mode  of  treatment,  and  would,  in  point  of  fact,  be  very  use- 
ful. But  in  this  contingency  they  are  almost  always  inapplicable,  for  it  is  neces- 
sary to  have  regard  to  the  exigencies  of  each  particular  case.  How  could  a  young 
husband  accept  our  prescription  to  pomade  and  bundle  himself  up  every  night, 
and  then  present  himself  in  such  attire  in  the  conjugal  bed  ?  Such  a  plan  of 
medication  would  little  favor  the  concealment  of  a  condition  which  the  patient  has 
a  special  interest  in  concealing. 

f  I  do  not  say,  be  it  understood,  that  a  treatment  of  this  kind  should  be  applied 


140      -  SYPHILIS  AND  MARRIAGE. 

As  an  example  of  this  kind,  I  will  cite  the  case  of  a 
patient  that  I  treated  in  this  way,  five  years  ago,  for  a 
syphilis  breaking  out  the  tenth  day  after  his  mar- 
riage. This  young  man  (whose  history  is  exactly  identi- 
cal, as  regards  peculiarity  of  debut,  with  one  of  our  pre- 
ceding cases) — this  young  man,  I  say,  a  fortnight  before 
his  nuptials,  in  compliance  with  the  traditional  ceremony 
called  Venterrement  de  la  me  de  gargon.,  passed  the  night 
with  a  former  mistress  whom  he  thought  safe.  He  thus 
acquired  the  pox,  w^hich,  after  an  incubation  of  twenty- 
five  days,  manifested  itself  by  a  chancre  on  the  gians.  The 
situation  was  then  most  critical.  I  employed  the  method 
which  I  have  just  mentioned,  and  I  have  the  satisfaction 
of  saying  that  it  was  crowned  mth  complete  success. 
The  secondary  period  remained  almost  entirely  quiet ;  all 
risk  of  contagion  was  averted;  all  was  saved,  "even  to^ 
appearances,"  following  the  expression  of  my  patient. 
And  yet  it  was  not  without  difficulty  that  I  prevailed  upon 
him  to  undergo  this  severe  treatment.  Many  times  he 
kicked  against  my  prescriptions,  against  what  he  called  my 
"horse-treatment,"  but  which  I  myself  would,  in  more  ex- 
act terms,  characterize  as  "a  treatment  for  the  use  of 
syphilitic  husbands  who  do  not  wish  to  infect  their  wives." 

The  first  point  in  the  situation  which  occupies  us  set- 
tled, let  us  now  proceed  to  a  consideration  of  the  second, 
which  relates  to  the  dangers  of  contagion  incurred  by  the 
wife.  These  dangers  you  will  recognize  from  what  pre- 
cedes.    They  are  of  two  orders  : 

1.  Dangers  of  direct  contamination  from  the  transmis- 
sion of  a  contagious  accident  from  the  husband. 


in  all  cases  ;  but  I  say — which  is  quite  different — that,  in  cases  where  it  can  be 
applied^  it  ought  to  be  made  use  of.  It  constitutes,  in  effect,  the  surest  means  of 
preventing  the  contagious  manifestations  of  the  secondary  period. 


HUSBAND  SYPHILITIO  AND    WIFE  EEALTEY.       141 

2.  Dangers  of  indirect  contamination,  resulting  from  a 
pregnancy  (syphilis  by  conception), 

IS'ow,  it  is  a  question  of  the  preservation  of  the  young 
wife  from  these  two  perils.  With  this  object  in  view, 
what  must  be  done  % 

As  regards  the  dangers  of  direct  contagion,  our  role, 
our  duty,  is  all  traced  out :  it  is  to  warn  the  husband 
upon  this  particular  point  in  a  manner  the  most  explicit, 
the  most  complete  ;  it  is  to  frighten  him  a  little  as  to  the 
risks  incurred  by  his  wife.  A  little  scare  would  not  be 
harmful,  in  order  to  render  him  more  cautious  and  more 
prudent. 

Inform  the  husband,  then,  exactly  of  the  dangers  of 
such  contagion — dangers  which  he  can  not  be  aware  of,  at 
least  sufficiently.  Do  not  restrict  yourself  to  simply  say- 
ing to  him  (as  is  generally  done),  that  he  may  be  con- 
tagious, and  that  he  ought  to  abstain  from  all  intercourse 
with  his  wife,  in  case  he  should  be  affected  with  any 
syphilitic  symptoms.  That  is  too  vague.  Press  the  mat- 
ter home  to  him  ;  do  not  fear  to  enter  into  details,  for  it 
is  worth  the  pains,  and  convince  him  thoroughly  of  this — 
that,  in  his  state  of  disease,  every  sore,  every  erosion, 
every  lesion,  excoriative  or  humid,  contains,  or  may  con- 
tain, a  germ  of  contagion  ;  that  however  slight,  however 
insignificant,  however  innocent  any  lesion  whatever  may 
appear  to  him,  that  lesion  is  no  less  dangerous  on  this 
account ;  that  it  matters  not,  besides,  what  may  be  the 
situation  of  a  lesion,  as  far  as  its  contagiousness  is  con- 
cerned; that  there  may  be  contagious  lesions  in  the 
mouth  as  well  as  upon  the  genital  organs,  etc^'    Then 

.  *  A  widespread  opinion  among  the  laity  is  that  syphilitic  contagion  can  only 
be  transmitted  by  the  genital  organs.  For  them,  the  idea  of  syphilis  implies  that 
of  a  genital  contamination.     This  is  an  error  which  it  is  important  to  correct  on 


142  SYPHILIS  AND  MARRIAGE, 

you  will  add,  in  conclusion,  "  That  loMch  you  haw  im- 
poses upon  you  the  express,  absolute  obligation  to  abstain 
from  all  intercourse,  from  all  contact  with  your  wife,  for 
there  may  result  from  it  the  worst  of  contagions  to  her." 

And,  gentlemen,  you  are  not  only  authorized  to  say 
this,  but  it  is  your  duty  to  say  it,  and  in  these  terms  ;  for 
such  statements  are  in  perfect  harmony  with  the  facts  of 
science  relative  to  the  usual  mode  of  contagion  in  mar- 
riage. 

Do  you  know  what  clinical  observation  actually  teaches 
upon  this  subject  ?  My  notes  are  absolutely  explicit  in 
this  regard,  and  permit  me  to  affirm  these  two  proposi- 
tions : 

1.  In  the  enormous  majority  of  cases,  tlie  syphilitiG 
contagions  transmitted  in  marriage  from  hushand  to 
wife  are  derived  from  secondary  forms  of  accidents. 

2.  These  contagions  are  almost  invariably  derived 
from  secondary  accidents  of  a  superficial,  erosive,  or  ex- 
ulcer  ative,  at  most,  papulo-erosive  form — that  is  to  say, 
from  accidents  essentially  benign  in  appearance — almost 
insignificant,  by  reason  of  their  seeming  benignity,  with- 
out importance,  upon  the  whole,  and  quite  susceptible 
of  being  misunderstood  as  regards  their  nature,  or  of  even 
passing  unx)erceived.  And  it  is  evident  that  this  twofold 
proposition  results  from  the  essential  nature  of  these  con- 
ditions. 

For,  on  the  one  hand,  syphilis  is  infinitely  more  dan- 
gerous in  its  secondary  stage  than  at  any  other  period,  by 
reason  of  the  extreme  multiplicity  and  the  possible  dis- 
semination of  its  accidents ;   and,  on  the  other  hand,  the 

contagions  which  take  place  in  marriage  can  only  be  the 

« 

every  occasion,  and  more  especially  still  in  the  class  of  situations  which  we  are 
now  considerinET. 


■  HUSBAND  SYPEILITIG  AND    WIFE  HEALTHY.       143 

result  of  lesions  so  unimportant  that  the  husband,  con- 
scious of  his  condition,  disregards  them,  or  fails  to  recog- 
nize their  existence.  A  husband,  in  fact,  does  not  infect 
his  wife  as  prostitutes  are  infected,  who,  from  interest  or 
indifference,  indulge  in  coition,  whatever  may  be  the  con- 
dition of  their  health  ;  a  husband  never  transmits  syphilis 
to  his  wife,  except  through  ignorance  or  inadvertence. 
Then,  he  transmits  it  to  her  only  through  the  medium 
of  lesions  so  minute,  so  benign,  that  he  has  not  suspected 
their  true  nature,  or  may  not  even  have  been  conscious 
of  their  existence. 

I  have  often  said,  and  I  shall  not  cease  to  repeat  it,  the 
slightest  accidents  of  the  secondary  period  are  the  most 
dangerous  as  regards  contagion.  And  they  are  the 
most  dangerous  by  reason  even  of  their  apparent  be- 
nignity. They  seem  to  be  so  trifling,  they  have  an  ap- 
pearance so  innocent,  that  one  disregards  them,  that 
one  does  not  suspect  their  nature ;  and,  consequently, 
one  is  so  much  the  more  liable  to  communicate  them. 
Let  us  add,  moreover,  that  they  may  easily  pass  en- 
tirely unperceived. 

The  small  secondary  erosions  of  the  lips,  of  the  tongue, 
of  the  penis,  are  the  most  usual  sources  of  contagion  in 
marriage.  Recall,  as  examples  of  this,  two  cases  which  I 
cited  to  you  at  the  beginning  of  this  exposition.  In  one, 
the  contagion  was  transmitted  by  secondary  erosions  on 
the  glans,  which  had  been  taken  for  herpes  ;  in  the  other, 
it  was  the  result  of  minute  erosions  of  the  lips — erosions 
scarcely  desquamative,  and  altogether  comparable  to  those 
epithelial  exfoliations  occasioned  by  the  abuse  of  tobacco. 
Well,  to  these  two  cases  I  could  add  at  least  fifty  others, 
all  testifying  to  the  same  effect.  Almost  invariably,  then, 
it  is  by  these  minute  lesions,  by  these  simply  erosive  sec- 


14:4:  SYPHILIS  AND  MARRIAGE. 

ondary  syphilides,  that  syphilis  passes  from  the  husband 
to  the  wife. 

This  is  so  true,  that  patients  as  attentive  as  possible 
to  the  state  of  their  health,  as  conscientious  observers  of 
themselves  as  could  be  imagined,  suffer  contagions  of  this 
kind  to  happen.  Physicians,  even,  thoroughly  competent 
observers,  have  not  escaped  this  danger  in  their  own 
families.  The  following  case  is  an  example,  which  I  con- 
sider worthy,  in  every  respect,  of  being  cited  to  you :  A 
most  distinguished  physician,  one  of  those  men  who  do 
honor  to  our  profession  as  much  by  their  personal  char- 
acter as  by  their  talent,  contracted  syphilis  in  the  exercise 
of  his  art.  Being  married,  he  immediately  forewarned 
his  wife,  and  watched  himself  mth  the  most  scrupulous 
care.  Each  day,  night  and  morning,  he  examined  himself 
with  the  greatest  attention.  And,  nevertheless,  in  spite 
of  all  his  vigilance,  he  finally  infected  his  wife.  Let  us 
hear  him  recount  his  misfortune,  in  a  letter  which  he  did 
me  the  honor  to  address  me  upon  this  subject :  "  One 
morning  last  year,  upon  awakening,  I  was  astounded  to 
observe,  in  the  furrow  of  the  glans,  a  small  spot  scarcely 
apparent,  of  the  size  of  a  lentil,  dry  in  almost  its  whole 
extent,  the  center  slightly  excoriated,  in  a  point  of  surface 
comparable  to  the  head  of  a  pin.  I  was  astounded,  be- 
cause the  night  immediately  preceding  this  discovery  I 
had  had  connection  with  my  wife.  And,  nevertheless,  I 
had  examined  myself,  as  was  my  custom,  the  evening 
before.  .  .  .  Now,  it  was  undoubtedly  this  miserable  pim- 
ple, this  insignificant  lesion,  which  infected  my  poor 
wife.  For,  after  the  classic  delay — that  is  to  say,  three 
weeks  later — she  commenced  to  feel  a  hardness  upon  the 
vulva,  which  soon  developed  into  a  chancre.  Let  not  my 
example  be  lost.     Let  it  be  of  advantage  to  you,  my  dear 


HUSBAND  SYPHILITIC  AND    WIFE  HEALTHY.       145 

Mend,  who  are  occupied  with  such  special  studies,  in 
order  to  tell  those  who  will  hear  you  how  contagion 
may  be  produced  in  marriage,  in  order  to  convince  them 
that  this  contagion  may  be  effected  by  a  lesion  the  most 
slight,  the  most  inoffensive — so  inoffensive,  so  slight,  as  to 
escape  the  suspicious  eye  of  an  honest  husband  and  of  an 
attentive  and  watchful  physician." 

There  is  nothing  to  add,  after  this  sad  and  very  in- 
structive example. 

This  is  not  all,  gentlemen.  A  third  point  claims  our 
attention.  You  have  not  lost  sight  of  the  situation,  the 
study  of  which  we  are  pursuing.  A  married  man  has 
come  to  ask  your  counsel  for  the  accidents  of  sy]3hilis. 
In  the  first  place,  you  have  prescribed  a  treatment  for 
him.  In  the  second  place,  you  have  put  him  on  his 
guard  against  the  dangers  incurred  by  his  wife  fi'om  direct 
contagion.  Your  task  is  not  finished ;  there  remains  the 
danger  of  a  pregnancy  ;  and  this  pregnancy,  occurring 
under  such  conditions,  would  be  the  occasion  of  a  double 
misfortune,  viz.  :  of  a  misfortune  which  concerns  the 
mother,  in  exposing  her  to  the  danger  of  receiving  the 
syphilis  from  her  child  ;  of  a  misfortune  which  concerns 
the  child,  which  would  be  subjected  to  all  the  risks  of 
sj^philitic  heredity,  J^ow,  upon  you  devolves  the  duty 
of  preventing  this  double  disaster. 

It  is  to  be  assumed  that  your  patient  has  no  idea,  or 
that  he  has  a  very  incomplete  understanding,  of  the  per- 
nicious results  which  may  succeed  a  pregnancy  occurring 
in  these  conditions.  It  is  your  duty,  then,  to  enlighten 
him  upon  this  point,  and  to  enlighten  him  in  extenso, 
clearly,  comprehensively,  so  that,  with  a  full  knowledge 
of  the  situation,  he  shall  know  how  to  regulate  his  con- 
duct. 


146  SYPHILIS  AND  MARRIAGE. 

Consequently,  in  order  to  fulfill  this  last  indication, 
you  will,  if  you  trust  to  me,  continue  your  advice  with 
special  reference  to  three  points,  as  follows  : 

"And,  especially,  sir,  under  the  present  circumstances, 
there  must  be  no  child.  Guard  well  against  pregnancy ; 
avoid  at  any  price  your  wife  becoming  enceinte! — for, 
on  the  one  hand,  the  infant  which  she  would  conceive  by 
you  might  either  inherit  your  disease,  or,  more  likely  still, 
die  before  being  born  ;  and,  on  the  other  hand,  your  wife 
might  be  infected  by  her  infant — that  is  to  say,  might 
receive  from  this  infant  the  pox  which  it  would  have  in- 
herited from  you.  Then,  you  understand  me  well,  you 
must  arrange  not  to  have  a  child." 

And  you  are  at  liberty,  gentlemen,  to  insist,  if  need 
be,  and  to  add  a  complement  of  instructions,  as  you  may 
judge  necessary,  according  to  the  attitude  of  your  pa- 
tient ;  you  are  at  liberty,  as  M.  Diday  has  very  properly 
said,  "to  make  yourself  teacher  even  as  to  the  most 
minute  details — teacher  always  decent,  but  sufficiently 
clear." 

Such,  gentlemen,  is  the  first  of  the  situations  which 
syphilis  creates  in  marriage. 

However  complex  and  delicate  this  situation  may  be 
in  more  than  one  point,  it  is,  nevertheless,  the  simplest  of 
all  as  regards  the  medical  indications  which  it  compre- 
hends. 

Let  us  pursue  our  study,  then,  expecting  difficulties 
much  more  serious. 


CHAPTER  XIII. 

HUSBAND   SYPHILITIC  ;    WIFE  HEALTHY,   BUT  EIS'CEINTE. 

A  SECO]S"D  order  of  cases  is  presented,  as  follows :  A 
man,  recently  married,  has  been  reattacked  with  specific 
accidents,  resulting  from  a  syphilis  incompletely  treated 
during  his  bachelor  life.  His  wife  remains  nncontami- 
nated,  but  she  is  enceinte.  And,  justly  alarmed,  this 
man  comes  to  request  your  advice,  submitting  to  you  this 
double  question : 

"1.  What  ought  I  to  do  for  myself  ? 

"2.  Is  there  anything  to  be  done  for  my  wife  and  the 
infant  which  she  carries  in  her  womb  ? " 

This  second  situation  is  much  more  complex  than  the 
one  we  have  previously  studied,  since  it  embraces  all  the 
difficulties  of  the  first,  with  the  grave  complication  of  a 
pregnancy  superadded. 

What  is  the  physician's  duty  in  such  a  case  ? 

I.  As  far  as  the  husband  is  concerned,  there  is  no 
embarrassment.  Our  role  is  exactly  what  is  was  in  the 
first  order  of  cases  previously  considered,  and  we  have 
nothing  to  do  but  to  prescribe  a  treatment  appropriate  to 
the  character  of  the  existing  accidents,  and  to  put  our 
patient  on  guard,  by  properly  given  advice,  against  the 
possibility  of  a  contagion  which,  in  this  case,  would  have 


148  STPEILIS  AFD  MARRIAGE. 

results  doubly  unfortunate,  since  a  wife  and  a  child  are  at 
the  same  time  interested.* 

II.  But  it  is  in  that  which  concerns  the  wife  and  child 
that  you  will  encounter  the  real  practical  difficulties.  It 
is  evident  that  both  are  threatened.  In  the  first  place, 
this  young  mother  may  be  contaminated  by  this  offspring 
of  a  syi3liilitic  father,  whose  syphilis  is  still  sufficiently 
active  to  manifest  itself  by  present  accidents.  Then  arise 
all  the  dangers  of  syphilis  by  conceiDtion.  On  the  other 
hand,  this  infant  is  liable,  from  its  hereditary  dangers, 
either  to  be  born  syphilitic,  or  (which  is  most  commonly 
the  case)  to  die  before  being  born. 

ISTow,  this  question  presents  itself :  May  we  not  hope 
to  ward  off  these  eminently  grave  results  by  anticipating 
them — that  is  to  say,  by  administering  specific  treatment 
to  the  mother  prophylactically  ?  Is  not  the  attenuating 
and  corrective  influence  of  this  treatment  demonstrated 
in  cases  which,  if  not  identical,  are  at  least  analogous? 
Have  we  not  seen,  for  example,  the  opportune  adminis- 
tration of  anti-syphilitic  medication  cut  short  a  series 
of  successive  abortions,  resulting  from  paternal  syphilitic 
influence,  and  conduct  a  pregnancy  to  full  tenn  ?  The 
intervention  of  preventive  treatment  has  here,  then,  at 
least  a  rational  indication. 

But,  on  the  other  hand,  are  we  Justified  in  this  pre- 

*  In  reference  to  this  last  point,  I  have  thought  it  useless  to  remind  you  that  a 
contagion  transmitted  in  the  course  of  a  pregnancy  involves  a  twofold  order  of 
dangers,  viz. :  1.  Dangers  relative  to  the  mother ;  these  are  only  too  evident.  2. 
Dangers  relative  to  the  infant.  It  may  happen  that  the  invasion  of  syphilis  in  the 
course  of  pregnancy  may  determine  either  an  abortion  or  &  premature  accouchement. 
It  may  happen,  also,  that  the  infection  of  the  mother  may  he  transmitted  to  the  foetus, 
with  all  the  serious  consequences  of  a  congenital  diathesis.  Facts  of  this  kind  are 
so  common  that  it  will  suffice,  I  think,  to  simply  announce  them,  without  bringing 
new  proofs  to  their  support.  Many  examples,  moreover,  will  be  incidentally  fur- 
nished in  the  statistics  which  may  be  found  at  the  end  of  this  volume  (vide  "  Illus- 
trative Cases,"  Note  III). 


HUSBAND  SYPHILITIC;   WIFE  HEALTHY— ENCEINTE.    149 

ventive  intervention  ?  What  do  we  actually  know  of  the 
state  of  the  infant  ?  whence  do  we  derive  our  fears  for  the 
mother  ?  Without  doubt,  this  infant  runs  risks  of  pater- 
nal hereditary  infection :  that  is  incontestable.  But  we 
have  previously  shown  that  syphilitic  heredity  has  no- 
thing inevitable  in  it,  especially  when  derived  from  the 
father.  It  may  be  that  the  infant  has  received  nothing 
from  its  father ;  and,  in  this  case,  the  mother  has  nothing 
to  fear  from  the  infant.  It  may  be,  then,  that  our  inter- 
vention would  be  without  object. 

In  this  uncertainty,  what  is  to  be  done  ?  Is  it  neces- 
sary to  resolve  upon  a  treatment  directed,  perhaps,  against 
illusory  dangers  ?  Or,  indeed,  should  we  trust  to  expecta- 
tion, and  "run  the  chances,"  as  it  is  commonly  termed? 
This  is  a  grave  question  as  regards  results ;  and  a  ques- 
tion, unfortunately,  still  undecided  in  the  present  state  of 
science. 

To  no  purpose  will  you  interrogate  your  books  upon 
this  subject ;  vainly  will  you  search  for  a  precise,  cate- 
gorical solution.  In  the  greater  number  of  our  classical, 
special  treatises,  the  problem  is  not  even  stated.  And  if 
you  consult  professional  opinion,  as  I  have  done,  you  will 
find  it  singularly  hesitating  upon  this  subject.  For  my 
part,  I  have  tried  this  experiment :  I  instituted  a  sort  of 
inquiry  upon  this  matter,  and  consulted  a  great  number 
of  physicians,  and  I  arrived  at  this  result :  that  certain  of 
our  confreres  express  themselves  resolutely  in  favor  of 
preventive  treatment ;  that,  to  others,  this  practice  is  re- 
pugnant ;  while  the  greater  number  have  no  settled  ideas, 
and  remain  undecided,  wavering  between  two  contrary 
opinions. 

I  wished  to  have,  in  order  to  communicate  it  to  you, 

the  opinion  of  an  illustrious  master — of  the  man  who  is. 
11 


150  •  SYPHILIS  AND  MARRIAGE. 

the  most  often  found  grappling  witli  difficulties  of  tMs 
kind,  and  whose  vast  experience  is  so  valuable  to  consult. 
I  went,  therefore,  a  few  days  since,  to  confer  with  M. 
Ricord  upon  this  special  subject,  and  I  found  him,  also, 
hesitating  and  uncertain.  "It  would  be  impossible  for 
me,"  he  replied,  "to  give  a  categorical  solution  of  the 
grave  question  of  which  you  speak,  and  one  which  has 
deeply  interested  me  for  a  long  time.  However,  from  my 
own  experience,  I  have  been  led  to  believe  that  the  part 
of  inaction,  of  expectation,  is  altogether  the  most  judi- 
cious in  this  matter.  .  .  .  Whatever  may  be  my  desire  to 
save  a  compromised  future,  it  is  repugnant  to  me  to  act 
at  hazard,  to  try  a  campaign  of  adventure.  I  am  loath  to 
condemn  to  a  mercurial  treatment  a  young  woman  who 
has  at  present  nothing  syphilitic  ;  v/ho  may,  indeed,  both 
she  and  her  infant,  have  escaped  the  pox,  and  whom,  be- 
sides, a  treatment  would  not,  perhaps,  save  from  the  pox 
if  she  had  already  received  it.  .  .  .  Still,  I  do  not  con- 
demn, I  have  not  the  right  to  condemn,  those  who  think 
otherwise,  who  base  their  practice  upon  an  intention  cer- 
tainly rational  in  thus  taking  a  salutary  precaution.  .  .  . 
It  is  for  further  experience  to  decide.  But,  at  present,  I 
confess  that  my  preferences  are  for  the  expectant  doc- 
trine; and,  should  a  case  of  this  kind  present  itself  to 
me  to-day,  I  should  remain  inactive,  rather  than  act  at 
random." 

Such  is,  likewise,  the  rule  of  conduct  which  I  should 
follow,  for  my  part — still,  without  having,  I  confess,  rea- 
sons clinically  sufficient  to  justify  it. 

Definitely,  then,  you  see,  gentlemen,  the  question  re- 
mains undecided.  It  is  not  because  it  is  still  new,  but  it 
is  so  delicate,  so  difficult  to  appreciate  in  a  categorical 
manner,  that  there  is  no  occasion  to  be  astonished  at  the 


HUSBAND  SYPHILITIC;   WIFE  HEALTHY— ENCEINTE.    151 

absence  of  a  precise  solution.  See  liow  the  clinical  ob- 
servations, which  conld  alone  serve  to  decide  the  question, 
are  really  susceptible  here  of  opposite  interpretations. 
Paternal  heredity  is  not  inevitable,  as  I  have  many  times 
said  to  you.  So  that  the  children  of  syphilitic  fathers  are 
sometimes  born  living  and  healthy ;  sometimes  they  die 
in  utero,  or  are  born  syphilitic.  Likewise,  they  some- 
times leave  their  mothers  uncontaminated,  and  sometimes 
they  react  upon  them,  communicating  syphilis  to  them. 

!N"ow,  suppose  that  in  a  case  of  the  kind  we  are  con- 
sidering we  try  the  intervention  of  treatment.  The  wife 
is  confined  at  term  of  a  healthy  child,  which  remains 
healthy.  Should  we  be  authorized  in  attributing  this 
happy  result  to  the  treatment  ?  But  we  are  immediately 
told  that  ' '  v/ithout  treatment  the  thing  occurs  just  the 
same,"  and,  in  support  of  this  statement,  a  certain  num- 
ber of  well-authenticated  facts  may  be  invoked.  In  order 
to  judge  this  question  conclusively,  it  would  be  necessary 
to  make  use  of  a  considerable  number  of  observations  of 
this  kind,  drawing  a  parallel  upon  a  very  large  scale  be- 
tween the  results  of  therapeutic  intervention  and  those  of 
expectation.  Then,  before  the  imposing  figures  of  such 
statistics  every  one  would  be  forced  to  bow.  Unfortu- 
nately, statistics  of  such  convincing  importance  are  stiU 
wanting  to  us,  and  I  am  forced  to  repeat,  in  conclusion, 
that  the  problem  remains  simply  stated,  without  any  pos- 
sibility of  a  solution  being  assigned  it  at  present. 

I  shall  make,  nevertheless,  one  reservation.  There  are, 
in  my  opinion,  particular  cases  where  the  doctrine  of 
expectation  ought  to  be  abandoned,  and  give  place  to 
an  active  intervention.  What  are  the  cases  to  which  I 
refer  ?  I  will  specify  by  an  example :  a  healthy,  well- 
developed  woman,  married  to  a  syphilitic  man,  has  had 


152,  STPEILTS  AND  MARRIAGE. 

several  miscarriages  in  succession,  and  that  without 
cause,  without  reason.  You  examine  her  most  carefully, 
and  you  find  no  other  plausible  explanation  than  the 
syphilis  of  the  husband. 

Now,  this  woman  again  becomes  enceinte.  Anxious  as 
to  the  result,  she  comes  to  consult  you,  or  (what  is  more 
common)  one  of  her  family — her  husband,  for  example — 
comes  to  consult  you  on  her  account.  In  these  circum- 
stances, shall  you  remain  inactive  ?  No,  certainly  not ; 
for,  on  the  one  hand,  you  know,  from  the  experience  of 
the  past,  how  expectancy  would  again  result,  at  least, 
according  to  every  probability ;  and,  on  the  other  hand, 
you  have  at  your  disposition  a  treatment  which,  directed 
against  the  probable  cause  of  these  successive  miscar- 
riages, may  weaken  and  correct  this  cause.  Why  not 
make  use  of  this  resource  ?  Why  not  have  recourse  to 
this  treatment  ?  Here,  at  least,  is  a  chance  to  be  gained  ; 
and  this  chance  you  have  not  the  right,  it  seems  to  me,  to 
■withhold  from  your  patient.* 

For  my  part,  in  such  conditions,  I  do  not  hesitate  to 
prescribe  specific  medication  as  the  sole  means  capable  of 
parrying  the  danger  which  threatens  the  child,  and  of 
conducting  the  pregnancy  to  term,  I  do  not  hesitate  to 
prescribe .  mercury.  I  consider  myself  justified  by  the 
needs  of  the  case  in  disguising  it  from  the  young  wife 
under  a  respectable  pseudonym,  in  concert  with  the  hus- 
band. x\nd,  if  I  am  not  mistaken,  I  believe  I  can  claim 
that  this  practice  has  often  furnished  me  with  real,  incon- 
testable successes. 

*  Professor  Depaul  has  developed  the  same  opinion  in  his  Clinical  Lectures. 
According  to  him,  "  After  a  series  of  miscarriages,  for  which  we  can  not  find  a 
cause,  the  physician  is  justified  in  prescribing,  empirically,  a  specific  medication — 
a  medication,  moreover,  inofEensive  when  it  is  properly  administered." 


CHAPTER  XIV. 

HUSBAND   SYPHILITIC   AND   WIFE  EECENTLY  CONTAMI- 
NATED. 

Thied  situation,  which  is,  tinfortunately,  the  most 
common.  A  sypJiilitic  sicbject  married  Jias  infected  Ms 
wife. 

Summoned  in  such  conditions,  what  have  you  to  do  ? 
What  medical  indications  present  themselves  to  be  ful- 
filled? 

"  The  matter  is  most  simple,"  you  will  perhaps  say  to 
me;  "we  have  here  two  patients;  well,  we  will  treat 
these  two  patients."  Without  doubt ;  but  that  does  not 
terminate,  ought  not  to  terminate,  your  role,  which,  in 
reality,  is  much  more  complex  than  you  would  at  first 
suppose.  You  are,  let  us  assume,  in  actual  practice,  and 
you  are  about  to  experience  the  difficulties  of  practice, 
which  one  can  not  fully  appreciate  unless  he  has  served 
a  personal  apprenticeship. 

Let  us  be  explicit. 

I.  In  regard  to  the  husband  there  is  no  embarrass- 
ment. As  far  as  he  is  concerned,  there  is  nothing  to  do 
but  this : 

1.  To  prescribe  for  him  a  treatment. 

2.  To  intimate  to  him,  in  the  most  direct  and  forcible 
manner,  the  interdiction  of  paternity. 


154  •  SYPHILIS  AND  MARRIAGE. 

You  Ivnow  well,  gentlemen,  liow  a  pregnancy  results 
when  botli  parents  are  contaminated  ;  especially  when  the 
maternal  syphilis  is  recent,  and  has  not  yet  been  sub- 
jected to  the  depurative  effect  of  treatment.  A  pregnancy 
in  such  a  condition  is  a  disaster.  Then,  it  will  be  your 
duty  to  enlighten  your  patient  upon  this  point,  and,  in 
order  to  leave  him  in  no  doubt,  you  should  address  him  in 
the  following  language:  "In  the  present  circumstances, 
with  the  disease  with  which  your  wife  and  yourself  are 
at  the  same  time  affected,  a  pregnancy  would  be  the  worst 
misfortune  which  could  befall  you.  For,  one  of  two  things 
would  happen  :  either  your  child  would  die  before  being 
born  ;  or  it  would  come  into  the  world  wifh  the  pox,  and 
you  may  imagine  the  effect  of  this  for  yourself,  for  your 
wife,  for  your  two  families,  for  others,  etc.  ;  without 
taking  into  account  that  the  poor  creature  could  not  long 
survive,  despite  all  care.  Then,  in  your  own  interest,  as 
in  the  interest  of  all,  avoid,  at  any  price,  the  possibility 
of  a  pregnancy  until  further  orders."  Such  is  the  urgent 
advice  to  give — ^more  easy  to  give  than  to  be  followed,  it 
appears,  as  we  shall  have  proof  in  a  moment. 

II.  Here,  then,  is  the  situation  regulated,  so  far  as  re- 
lates to  the  husband.  But  there  remains  the  wife.  And 
it  is  in  relation  to  her  that  there  is  about  to  begin  for  us 
a  most  delicate  situation — by  so  much  the  more  delicate, 
as  it  will  be  necessary  to  combine  mth  our  usual  preroga- 
tives the  role  of  the  tactician  and  the  diplomate. 

And,  in  reality,  in  the  large  majority  of  cases,  these 
things  hai^pen  in  such  a  way  that  the  wife  is  entirely  ig- 
norant of  the  disease  with  which  she  is  attacked,  and  it  is 
your  moral  duty  to  deceive  her  in  this  matter,  by  dis- 
simulating the  real  name  and  nature  of  her  affection. 
Why  ?    Because  nine  times  out  of  ten,  at  least,  the  situa- 


HUSBAND  SFPEILITIG;    WIFE  RECENTLY  INFECTED.    155 

tion  involves  you  with  it,  as  follows  :  The  young  husband 
who  has  infected  his  wife  rushes  distracted  to  his  physi- 
cian, and  thus  begins  the  interview  :  "Doctor,  a  great  mis- 
fortune has  befallen  me.  I  had  the  pox.  I  made  the 
mistake  of  marrying  before  being  completely  cured.  I 
have  given  the  pox  to  my  wife.  I  come  to  ask  you  to 
treat  her.  But,  above  all,  I  beg  this  of  you,  I  ask  it  of 
you  in  the  name  of  all  you  hold  most  dear :  do  not  dis- 
close the  truth  to  yoar  future  patient ;  keep  her  for  ever 
ignorant  of  the  name  and  nature  of  her  disease.  For,  if 
she  knew  this,  I  should  be  ruined  ;  it  would  be  the  death- 
blow to  her  affection  and  esteem  for  me.  And,  if  she 
should  tell  her  family,  imagine  the  result !  Then  i^romise 
me  your  best  care  for  her,  and,  at  the  same  time,  perfect 
discretion — an  absolute  silence  as  to  the  nature  of  her 
condition." 

Could  you,  gentlemen,  excuse  yourselves  under  such 
circumstances,  and  refuse  the  double  service  which  is  thus 
requested  of  you '?    Certainly  not. 

So  that,  at  the  first  step,  you  are  here  involved  in  a 
singular  predicament — that  of  a  physician  treating  a  pa- 
tient, with  the  obligation  to  conceal  from  her  the  disease 
for  which  he  treats  her.  A  singular  situation,  I  have  said, 
but  a  situation  to  be  accepted,  since  it  has  nothing  incom- 
patible with  our  professional  dignity ;  for,  after  all,  we 
are  not  responsible  for  this  situation  ;  we  only  submit  to 
it,  and  we  submit  to  it  from  a  motive  essentially  moral 
and  beneficent,  viz.,  with  a  view  of  concealing  a  culpable 
action,  and,  following  the  consecrated  expression,  of  pre- 
serving the  peace  of  a  family. 

On  the  other  hand,  gentlemen,  do  not  misapprehend 
the  difficulties,  altogether  special,  of  the  mission  which 
you  will  have  accepted  under  these  circumstances.     To 


156  S7PEILIS  AND  MARRIAGE. 

treat  a  woman  with  syphilis  (and  to  treat  her  a  long  time, 
as  is  necessitated  by  the  nature  of  this  disease),  without 
tliis  iDoman  ever  dlmning  or  sus'pecting  the  truths  is  a 
task  which  a  diplomate  might  undertake,  but  for  which 
a  physician  is  poorly  prepared.  And,  indeed,  it  will  be 
necessary  for  you  to  do  certain  things  to  which  you  have 
not  been  accustomed,  viz. ,  to  manoeuvre  in  a  line  of  per- 
petual dissimulation — to  satisfy  ex  ahruxoto  a  hundred 
questions  with  which  your  patient  will  besiege  you  : 
"IsTow,  doctor,  what  is  it  I  have  ?  What  are  you  treating 
me  for  \  How  did  I  take  this  disease  %  How  does  it  hap- 
pen that  I  have  the  same  symptoms  as  my  husband  % " 
etc. — to  confer  upon  the  different  morbid  manifestations 
which  arise  different  i)seudonyms,  which  must  be  irre- 
proachable, acceptable,  probable — to  mask  under  imagi- 
nary names  the  specific  remedies  which  you  will  have  to 
prescribe ;  and,  in  all  this,  never  to  hesitate  or  evade  for 
an  instant,  never  to  betray  yourself. 

ISTow,  this  role — as  you  v»411  appreciate  only  too  fully 
in  practice — comprises  more  than  one  difficulty ;  it  de- 
mands an  assurance,  an  aplomb,  an  address,  which  can 
only  be  acquired  by  practice.  In  brief,  it  is  less  easy, 
believe  me,  than  one  would  imagine  a  priori  to  manoeuvre 
upon  such  a  field ;  and  more  than  one  able  tactician  has 
succumbed  in  this  contest  with  feminine  acuteness.  Con- 
sider yourselves  warned,  then,  gentlemen,  and,  when  you 
engage,  or,  rather,  when  one  engages  you,  in  an  under- 
taking of  this  sort,  do  not  lose  sight  of  the  fact  that  you 
Avill  meet  your  match. 

And  yet,  be  assured,  the  women  that  we  pretend  to 
impose  upon  in  this  way  are  very  far  from  being  always 
the  dujoes  of  the  stratagem.  In  reality,  we  deceive  them 
much  less  often  and  less  completely  than  we  ourselves 


HUSBAND  SYPHILITIC;   WIFE  RECENTLY  INFECTED.    157 

think,  and,  especially,  than  their  husbands  think.  Many- 
times,  for  my  part  alone,  I  have  perceived  that  certain  of 
my  patients,  whom  I  thought  I  had  misled  as  to  the 
nature  of  their  disease,  knew  perfectly  well  what  was  the 
matter  with  them.  Only,  before  myself,  as  before  their 
husbands,  they  accepted — because  they  chose  to  accept 
it — the  role  of  deluded  wives.  Some  of  them,  more- 
over, after  a  certain  time,  place  the  physician  at  ease 
by  making  him  understand  that  they  are  aware  of  the 
situation.  "Now,  do  not  give  yourself  so  much  trou- 
ble," one  of  my  patients  said  to  me  one  day,  "to  per- 
suade me  that' I  have  a  disease  other  than  that  for  which 
you  are  treating  me.  I  have  for  a  long  time  understood 
the  nature  and  the  wherefore  of  my  disease.  Only,  so  far 
as  my  husband  is  concerned,  I  shall  always  remain  igno- 
rant, for  uny  dignity  obliges  me  to  ignore  tJiat  wliich  I 
could  not  pardon.''''  Another — a  woman  of  intelligence — 
you  will  pardon  me  the  anecdote — seemed  absolutely  con- 
fiding in  my  imaginative  diagnostics,  until  one  day  she 
disabused  my  mind  by  the  following  little  speech  :  "I  am 
very  much  obliged  to  you,  dear  doctor,  for  all  the  trouble 
which  you  have  for  so  long  a  time  taken  to  dissemble  the 
disease  with  which  I  am  affected  ;  and  you  might  have 
succeeded,  perhaps,  had  it  not  been  for  my  husband  and 
M.  Littre  ;  but  my  husband  guarded  too  preciously  your 
prescriptions  not  to  inspire  me  with  a  desire  to  read  them  ; 
and  I  have  read  them,  as  you  may  believe  ;  and  you  had 
forgotten  to  make  a  recommendation  to  M,  Littre  not  to 
indicate  in  his  dictionary  the  synonym  of  your  fallacious 
word  hydrargyrum."  These  things  happen  thus  quite 
frequently,  and  it  is  well  to  be  acquainted  with  them  for 
the  demands  of  practice. 

There  is  another  point  of  capital  importance.     If  it  be 


158  SYPHILIS  AND  MARRIAGE. 

difficult,  as  we  have  just  seen,  to  treat  a  woman  for  syphi- 
lis without  arousing  her  susi)icions,  it  is  much  more  diffi- 
cult still  to  treat  her  as  it  would  be  desirable  that  she 
were,  as  you  would  AAdsh  that  she  were  treated — that  is  to 
say,  in  an  energetic,  prolonged,  and  sufficient  manner. 

I  will  explain  myself,  and  I  shall  not  hesitate  to  insist 
upon  this  point,  for  a  considerable  interest,  which  merits 
all  our  solicitude,  is  attached  to  it. 

You  know  that  one  cures  the  pox,  or  rather  that  one 
definitely  imposes  silence  upon  the  manifestations  of  the 
pox,  only  at  the  price  of  a  longj-  very  long,  treatment,  re- 
quiiing,  at  the  minimum,  several  years.  You  know,  in 
addition,  that  this  treatment,  in  order  to  be  efficacious, 
requires  a  particular  direction — that  it  ought  to  be  by 
turns  interrupted,  recommenced,  stop^Ded  altogether,  re- 
sumed in  various  forms.  All  this  demands  much  time 
and  patience,  a  medical  supervision,  if  not  constant,  at 
least  iDrolonged.  In  a  word,  the  pox  is  a  chronic  disease, 
which  one  gets  rid  of  only  by  a  chronic  treatment. 

ISTow,  Judge  whether,  in  this  special  case,  such  a  treat- 
ment would  be  easily  applicable. 

In  the  first  place,  how  will  you  force  the  acceptance 
of  a  treatment  of  this  kind  upon  a  woman  who  is  ignorant 
of  the  nature  of  the  disease  with  which  she  is  affected,  to 
whom  you  have  not  the  right  to  explain  what  the  disease 
is,  what  its  multii)le  consequences  and  its  dangers  for  the 
future  may  be,  etc.  ? 

And  more,  how  make  a  woman  accept  this  treatment 
who  is  constantly  deceived  as  to  her  condition,  to  whom 
her  husband,  by  way  of  consolation,  or  in  extenuation  of 
a  fault  still  unavowed,  does  not  cease  to  repeat  to  her 
every  day  that  "what  she  has  is  nothing,"  that  "it  will 
soon  pass  away,"  etc.  ? 


HUSBAND  8YPEILITIG;    WIFE  RECENTLY  INFECTED.    159 

ITote,  moreover,  tliat  tlie  said  husband,  at  a  certain 
stage  of  the  malady,  as  soon  as  its  evident  manifestations 
have  disappeared,  as  soon  as  the  syphilis  no  longer  ex- 
poses itself  by  external  symptoms,  becomes  for  you  an 
auxiliary  less  than  ardent.  As  at  first  he  was  most  zeal- 
ous in  his  efforts  to  obtain  from  you  an  active  medica- 
tion, and  to  have  you  supervise  its  application ;  so,  later 
on,  you  will  find  him  lukewarm,  when,  the  ostensible  acci- 
dents having  been  effaced,  he  no  longer  insists  upon  a 
preventive  treatment.  You  were  "a  savior,"  you  were 
welcome  in  his  house  a  few  months  ago.  But  now  "that 
all  is  finished,"  "that  there  is  nothing  more  the  matter," 
your  presence  with  his  wife,  your  visits,  your  prescriptions, 
your  treatment,  "which,  without  doubt,  have  done  well, 
but  which  should  have  the  merit  of  being  less  prolonged," 
all  this  becomes  for  him  a  source  of  vexation,  of  irritation, 
of  disquietude,  by  renewing  disagreeable  souvenirs,  by 
prolonging  a  difllcult  situation,  naturally  calculated  to 
excite  suspicion.  In  brief,  to  speak  clearly,  this  hus- 
band longs  for  nothing  more  than  to  be  disembarrassed  of 
you  (the  word  is  strictly  exact),  and  your  disappearance 
from  the  scene  will  be  a  veritable  deliverance  for  him. 
Hence  this  lamentable  consequence,  viz.,  that  every  inar- 
ried  woman,  contracting  the  sypMlis  in  tlie  conditions 
wliicJi  we  are  now  considering,  will  never  he  otherwise 
than  insufficiently,  very  incompletely  treated,  and  will, 
on  that  account,  remain  exposed  to  the  most  serious  dan- 
gers in  the  future. 

Such,  gentlemen,  is  the  invariable  history  of  women 
who  have  been  infected  by  their  husbands.  In  the  be- 
ginning of  their  disease,  these  women  have  always  been 
treated  some  little  (exception  made  of  some,  who,  thanks 
to  the  selfishness  of  their  husbands,  have  received  no 


160  SYPHILIS  AND  MARRIAGE. 

treatment  whatever).  They  have  been  "whitewashed," 
permit  me  the  common  but  consecrated  expression.  Then 
the  i)hysician  is  hastened  into  relinquishing  a  treatment 
which  might  have  awakened  susj)icions,  and  become  com- 
promising for  the  husband.  As  soon  as  possible  the  phy- 
sician is  dismissed,  and  things  rest  there.  What  happens 
then?  The  syphilis,  be  it  well  understood,  does  not  re- 
linquish its  hold  upon  these  unfortunate  women,  despite 
their  quality  of  married  women,  of  honest  women  ;  and 
ten,  fifteen,  twenty  years  later  it  is  manifested  upon  them 
by  accidents  of  diverse  forms,  more  or  less  severe,  very 
serious  sometimes,  even  mortal. 

Add  to  this  another  consideration  still  more  aggra- 
vating :  that,  occurring  in  married  women,  who  appear 
guaranteed  from  syphilis  by  an  entire  past  of  irreproach- 
able morality  and  of  thorough  respectability,  these  specific 
accidents  of  the  tertiary  period  run  the  risk  very  often  of 
remaining  unrecognized,  and  consequently  they  are  not 
submitted  to  the  sole  treatment  which  is  appropriate  to 
them,  and  they  have  every  chance,  on  this  account,  of 
terminating  in  the  most  disastrous  results.  A  diagnostic 
error  as  to  the  nature  of  these  accidents  is,  in  such  a  case, 
more  than  easy  to  commit.  In  the  first  place  the  phy- 
sician, by  reason  even  of  the  character  of  the  person — I 
mean  by*  reason  even  of  the  presumed  antecedents  of  his 
patient — does  not  dream  of  syphilis  ;  he  is  far  from  sus- 
j)ecting  syphilis  in  the  virtuous,  respectable,  venerated 
surroundings  where  he  finds  himself  called.  Can  he  sus- 
pect it,  moreover,  when  he  receives  from  his  patient  no 
acknowledgment,  no  indication — for  the  excellent  reason 
that  this  woman  can  not  reveal  a  disease  of  which  she  has 
always  been  ignorant  ?  On  the  other  hand,  he  is  hardly 
more  enlightened — at  least,  ordinarily — by  the  husband, 


EUSBARD  SYPHILITIC;    WIFE  RECENTLY  INFECTED.    161 

by  no  means  eager  to  revive  a  compromising  past,  little  dis- 
posed to  confidences  whicli  lie  Judges  absolutely  useless, 
etc.  So  that,  as  an  almost  general  rule,  a  correct  diagnosis 
is  not  formed,  at  least  when  (which  is  the  exceptional 
case)  it  does  not  declare  itself  by  the  objective  character 
of  the  lesions.  And  I  leave  you  to  judge  of  the  conse- 
quences of  a  mistake  in  conditions  of  this  kind — that  is 
to  say,  in  presence  of  lesions  so  serious  as  those  of  ter- 
tiary syphilis.*  I  insist,  and  I  repeat,  that  among  women 
nothing  is  so  frequent  in  practice  as  tJie  tertiary  acci- 
dents of  syphilis  contracted  in  marriage.  Observations 
of  this  kind  abound  and  superabound.  I  count  them  by 
hundreds  in  my  notes  of  hospital  and  private  practice. 
And,  for  the  most  part,  for  the  enormous  majority,  they 
relate,  I  repeat  it,  to  women  who  have  been  treated  in  a 
very  insufficient  way  at  the  debut  of  the  disease,  who 
have  been  treated  only  for  the  time  actually  necessary 
to  dissipate  the  first  accidents,  in  order  to  save  appear- 
ances, and  exonerate  the  husband  from  responsibility 
most  quickly. 

Very  far  from  my  purpose,  assuredly,  is  it  to  pretend 
that  it  is  a  cold  and  cowardly  calculation  of  selfishness 


*  One  may  perhaps  say,  "  But  the  antecedents  of  the  patient  will  be  known  to 
her  own  physician,  who,  in  consequence,  will  not  mistake  the  nature  of  any  acci- 
dents which  may  afterward  happen."  "Yes,"  I  would  reply,  "if  the  physician 
called  to  examine  these  last  accidents  is  indeed  the  one  who  originally  treated  the 
patient.  But,  in  the  contrary  case — how  then  ?  Now,  there  are  numerous  chances 
that  the  contrary  case  will  be  frequently  met  with  in  practice.  It  most  often 
happens — this  is  the  result  of  experience — that  the  physician  who  is  called  upon  to 
treat  the  syphilis  of  a  woman  contaminated  by  her  husband  is  not  the  regular 
physician  of  this  patient.  Almost  always  he  is,  after  a  certain  time,  supplanted  by 
a  confrere,  and  this  through  the  agency  of  the  husband,  who  is  distrustful  and 
little  anxious  to  keep  near  his  wife  the  confidant  of  a  compromising  past.  Then, 
for  this  or  some  other  reason,  it  frequently  happens  that  the  antecedents  of  the 
patient  remain  unrecognized,  when  upon  these  alone  depends  the  establishment  ©f 
a  correct  diagnosis  as  to  the  nature  of  consecutive  accidents. 


162  SYPHILIS  AKD  MARRIAGE. 

which  induces  numbers  of  husbands  to  sacrifice  in  this 
way  the  future  of  their  wives  to  the  immediate  interests 
of  their  o^^Tl  dignity  ;  or,  from  personal  concern,  to  cover 
up  the  fault  of  which  they  have  been  culpable.  That 
would  be  an  unwarrantable,  exaggerated,  ridiculous  accu- 
sation. But  I  can  not  refrain  from  remarking  that  which 
exists,  and  from  reading  in  certain  facts  the  condemna- 
tion which  they  carry  ^vith  them.  I  can  not  refrain,  for 
example,  from  condemning  energetically  the  conduct  of 
those  husbands  who,  in  order  to  avert  suspicion,  do  not 
scruple  to  abridge  the  treatment  prescribed  for  their  wives, 
and  who  compromise  the  health  of  others  in  order  to  pre- 
serve what  they  call  "their  respectability."  Neither  can 
I  forbear  accusing  of  carelessness,  of  imprudence,  of  indif- 
ference, etc.,  such  others  as,  when  once  the  first  symptoms 
have  disappeared  from  their  wives,  do  not  further  concern 
themselves  with  what  may  follow ;  they  let  things  go  as 
they  will ;  they  repose  in  a  security  all  the  more  comj)lete, 
as  theh  own  health  is  not  in  jeopardy,  and  thus  pre- 
pare, with  an  absolute  indifference,  dreadful  catastrophes 
for  the  future.  Certainly,  examples  to  cite  in  justification 
of  the  preceding  are  not  wanting  to  me.  The  following, 
among  many  others,  will  strengthen  your  convictions : 

A  young  lady,  of  high  birth,  marries  a  syphilitic  man, 
and  is  very  soon  infected  by  him.  Thereupon,  great  com- 
motion. M.  Ricord  is  immediately  summoned,  and  treats 
the  patient.  Everything  disappears.  They  qiiickly  turn 
their  backs  on  M.  Ricord ;  they  have  no  further  use  for 
him  ;  they  would  almost  svv^ear  never  to  have  known  him. 
JSTevertheless,  the  syphilis  retains  its  potency,  and  reveals 
itself  by  the  ill-omened  results  of  three  pregnancies,  which, 
one  after  another,  produce  still-born  infants.  Several 
years  pass  in  peace.     Then  .the  young  wife  is  attacked 


HUSBAND  8TPHILITIG;    WIFE  RECENTLY  INFECTED.    163 

with,  singular  accidents  of  the  nose.  She  is  troubled,  with- 
out cessation,  with  a  "cold  in  the  head,"  and  the  dis- 
charge of  an  abundance  of  sanious  or  purulent  mucus 
from  the  nostrils.  !N"umerous  plans  of  treatment  are 
brought  into  requisition,  but  all  without  benefit.  Two 
seasons  of  sulphur-waters  produce  no  better  results.  A 
physician  at  this  Juncture  suspects  syphilis,  and  interro- 
gates the  patient  in  this  direction,  who,  in  the  ignorance 
of  her  specific  antecedents,  quite  naturally  defends  her- 
self by  indignant  denials.  The  husband,  who  is  present  at 
this  consultation,  remains  impassible  and  mute,  persuaded 
that  "  his  wife  has  been  cured  of  what  she  formerly  had, 
and  that  the  present  accidents  have  nothing  to  do  with 
the  little  misfortune  of  earlier  days."  Still  the  nasal 
lesions  continue  and  become  aggravated,  until  they  result, 
on  the  one  hand,  in  a  frightful  ozsena,  and,  on  the  other 
hand,  in  a  perforation  of  the  palate.  Then,  only,  does 
the  husband's  conviction  become  shaken.  Then,  only, 
does  he  consent  to  recall  M.  Ricord,  who  immediately 
recognizes  the  specific  nature  of  the  disease.  I  am  sum- 
moned in  turn,  and  have  only  the  easy  role  of  confirming 
both  the  diagnosis  and  the  treatment  of  my  illustrious 
master.  But  at  this  time  the  lesions  ha.ve  become  such 
that  the  whole  nasal  bony  structure  is  necrosed.  Three 
entire  years  this  unhappy  woman  is  condemned  to  abso- 
lute seclusion,  on  account  of  the  insupportable  odor  which 
she  spreads  around  her,  and  which  every  imaginable 
medication  succeeds  only  in  imperfectly  correcting.  She 
is  cured  only  after  the  expulsion  of  numerous  sequestra 
and  the  comi3lete  loss  of  the  palate. 

Likewise,  I  have  among  my  notes  numbers  of  other 
observations  relative  to  women  who,  after  having  acquired 
syphilis  from  their  husbands  at  the  beginning  of  marriage, 


164  SYPHILIS  AND  MARRIAGE. 

have  only  been  subjected  to  short  treatments,  and  have 
afterward  experienced  the  most  severe  tertiary  accidents 
— this  one,  for  example,  a  x^hagedenic  syphilide  which 
invaded  the  face,  and  disfigured  it  most  horribly ;  that 
one  the  loss  of  the  nose  ;  another  a  rectal  stricture,  which 
had  to  be  operated  upon,  with  failure  to  relieve  the  pa- 
tient ;  another  a  cirrhosis  which,  misunderstood  as  to  its 
nature,  carried  her  off  rapidly ;  still  another,  lesions  of 
the  cranial  bones  and  cerebral  gummata,  which  XDroduced, 
successively,  ei^ileptif  orm  attacks,  hemiplegia,  gradual  fad- 
ing of  the  intelligence,  dementia,  and  death  ;  etc.,  etc. 

Accidents  of  this  kind  are  certainly  qmiQ  common, 
and  I  do  not  give  them  to  you  as  constituting  manifesta- 
tions peculiar  to  the  order  of  cases  which  occupy  us  at 
this  moment.  But  certainly,  also,  it  is  at  the  same  time 
both  remarkable  and  distressing  that  such  accidents  are 
common  in  marriage.  Again,  they  are  frequently  en- 
countered in  the  highest  classes  of  society,  where  the 
multiple  conditions  of  social  position,  of  knowledge,  of 
civilization,  of  moral  training,  ought,  it  would  seem,  to 
exclude  such  shames.  Finally,  and  still  more,  they  im- 
pose a  responsibility  upon  those  who,  the  first  authors  of 
the  evil,  were  under  obligations  to  do  everything  to  avert 
its  terrible  consequences,  and  v^^ho,  notwithstanding,  have 
for  one  reason  or  another  evaded  this  direct  duty. 

In  such  circumstances,  gentlemen,  a  humanitarian  role 
is  also  imposed  upon  you  ;  and  this  role  you  have  already 
comprehended  in  advance,  you  have  already  anticipated 
in  the  course  of  the  preceding  discussion.  This  role  is  to 
take  care  of  the  woman  who  is  confided  to  you,  and  in  re- 
lation to  whom  you  have  until  now  only  been  the  accom- 
plice of  the  liushand,  charged  with  deceiving  her  as  to  the 
nature  and  possible  consequences  of  her  disease ;  it  is  to 


HUSBAND  SYPHILITIC;    WIFE  RECENTLY  INFECTED.    165 

protect  the  health  of  this  woman  in  the  present  and  in  the 
future  from  the  neglect  of  this  selfish  or  indifferent  hus- 
band ;  it  is,  in  a  word,  to  employ  every  means,  through 
your  double  influence  of  physician  and  man,  that  this  wo- 
man may  have  the  benefit,  like  every  other  patient,  of  an 
energetic,  prolonged,  active,  sufficiently  preservative  treat- 
ment. 

It  goes  without  saying  that  in  numerous  cases  this  role 
will  be  rendered  easy  by  the  good  disposition  of  the  hus- 
band, a  man  of  heart,  regretting  bitterly  the  misfortune  of 
which  he  is  the  cause,  and  ready  to  do  everything  in  his 
power  to  repair  his  fault.  It  will  suffice,  then,  to  explain 
to  him  the  future  dangers  to  which  his  wife  will  remain 
exposed  in  the  absence  of  a  sufficient  treatment,  in  order 
to  obtain  from  him  a  carte  hlancJie  relative  to  the  di- 
rection and  the  duration  of  your  therapeutic  interven- 
tion. 

But,  on  the  other  hand,  you  must  expect  to  encounter 
other  cases  where  your  position  will  become  much  more  de- 
licate, much  more  embarrassing  ;  when,  for  example,  you 
will  have  to  contend  with  the  selfishness,  the  indifference, 
the  prejudices,  the  fears,  the  ignorance,  of  the  interested 
principal.  In  such  a  case,  it  will  be  your  duty  by  your 
tact,  by  your  experience  of  the  human  heart,  to  struggle 
with  difficulties  of  diverse  kinds  in  the  best  interests  of 
your  patient.  It  will  be  your  duty  to  sustain  this  contest 
with  a  persevering  ability ;  and,  finally,  if  you  perceive 
yourself  overruled,  to  energetically  remind  the  husband 
of  the  duties  which  are  imposed  upon  him  as  upon  your- 
self in  such  a  situation.  I  do  not  advise  you,  assuredly, 
to  make  an  exposure,  to  pose  yourself  as  a  redresser  of 
wrongs,  to  undertake  the  ridiculous  role  of  a  Don  Quixote 
of  married  women.     But  what  I  say  to  you  is,  if  you  are 

12 


166  SYPHILIS  AND  MARRIAGE. 

forced  to  do  it,  attack  the  position  from  the  front,  by  ad- 
dressing to  the  husband  language  both  firm  and  severe, 
such  as  the  following,  for  example :  "  Without  doubt,  sir, 
it  may  be  extremely  disagreeable  to  j^ou  that  the  treat- 
ment of  your  wife  needs  to  be  still  continued  for  a  long 
time,  but  it  is  not  in  my  power  that  it  should  be  other- 
wise. I  have  consented,  in  order  to  save  you  from  a  false 
step,  to  be  your  accomplice  against  your  wife,  and  I  have 
given  you  my  word.  But  I  will  not  go  further,  and  I 
throw  ujDon  you  the  whole  responsibility  of  what  may 
follow,  in  case,  by  your  act,  the  treatment  should  not  be 
pursued  as  it  ought  to  be.  Honor  and  humanity  demand 
that  you  do  for  your  wife  what  you  would  think  necessary 
to  do  for  yourself.  Allow  me,  then,  to  finish  the  work 
begun,  and  complete  a  cure  which  ought  to  be  the  object 
of  our  common  efforts." 

You  may  be  sure,  gentlemen,  that  in  si)eaking  in  this 
way,  in  accepting  and  sustaining  the  role  which  I  have 
just  traced  for  you,  you  will  fulfill  a  moral  duty  of  which 
you  have  not  the  right  to  divest  yourselves.  Be  equally 
sure  that  you  will  accomplish  a  salutary  service  in  thus 
snatching  from  the  tertiary  grasps  of  the  diathesis  the 
unfortunate  women  w^ho  were  not  designed  for  the  pox, 
but  whom  the  selfishness  or  the  carelessness  of  their  hus- 
bands would  leave  easily  exposed  to  drain  to  the  dregs 
the  chalice  of  the  disease. 

Still  this  is  not  all,  and  you  have  not  yet  exhausted 
the  embarrassments  of  this  special  situation. 

On  the  other  hand,  indeed,  you  will  have  to  contend 
with  a  difficulty  of  a  different  order,  viz.,  with  the  repug- 
nances, with  the  resistances,  which  you  will  encounter 
from  the  person  interested,  on  the  part  even  of  the  patient 
that  you  have  to  treat ;  and  your  position  in  relation  to 


HUSBAND  8TPEILITIG;    WIFE  RECENTLY  INFECTED.    167 

her  will  demand  a  certain  cleverness,  even  a  certain  pro- 
fessional tact,  on  your  part.     I  explain  : 

You  have  cured  this  woman,  I  suppose,  of  her  first 
accidents.  All  has  disappeared ;  all  is  going  for  the  bet- 
ter. And  now  you  speak  of  a  new  treatment.  But  why 
this  treatment  ?  Wherefore,  and  for  what  indication  ? 
you  are  asked.  Admit  that  your  remedies  are  again 
accepted  this  time.  But  what  welcome  will  you  receive 
when  you  return  to  the  charge  a  third,  a  fourth,  a  fifth 
time,  etc.  ?  And,  nevertheless,  necessity  imposes  this  ; 
you  must  obtain  this  from  your  patient ;  it  is  the  price  of 
her  cure.  This  difficulty — and  many  others  of  the  same 
kind — you  will  only  overcome  by  dint  of  patience,  of  pro- 
fessional tact,  of  practiced  cleverness.  You  will  only 
overcome  them  by  being  able  to  exercise  over  your  pa- 
tient an  authority  which  vsdll  assure  her  confidence  and 
render  her  docile  to  your  prescriptions. 

Then,  in  view  of  the  future,  do  not  neglect  to  establish 
the  situation  well  at  your  first  visit,  and  that  in  a  sense 
the  most  favorable  to  the  purpose  you  have  in  view.  As- 
suredly, you  are  under  obligation  to  conceal  from  your 
patient  not  only  the  name  of  her  disease  but  the  special 
dangers  to  which  she  is  exposed,  and  the  terrible  conse- 
quences which  may  result  after  an  indefinite  period.  On 
the  other  hand,  however,  do  not  commit  the  mistake  of 
declaring  to  her,  as  her  husband  would  wish,  that  "she 
has  nothing,"  that  "her  affection  is  a  passing,  trifling  in- 
disposition, which  will  not  be  followed  by  consequences," 
etc.  On  the  contrary,  as  soon  as  you  may  judge  it 
prudent  and  opportune,  express  clearly  the  opinion  that 
her  present  symptoms  indicate  a  veritable  disease  —  a 
disease  which  you  may,  however,  disguise  under  whatever 
respectable  pseudonym  seems  to  you  best  under  the  cir- 


168  STPEILIS  AND  MARRIAGE. 

cumstances.  Let  her  understand  that  this  malady  will 
probably  be  of  long  duration  ;  that  it  may  have  disagree- 
able returns,  relapses,  recurrences.  Assure  her  that  the 
affection  to  which  she  is  subject  ought  to  be  the  object 
of  an  attentive  surveillance  ;  that  it  is  quite  curable,  with- 
out any  doubt,  but  that,  in  order  to  be  cured,  it  will  de- 
mand prolonged  care,  etc.  In  brief,  prepare  the  way  and 
anticipate  the  objections,  the  rebellions,  that  you  have  to 
fear  in  the  future,  by  indicating  in  advance  the  long  thera- 
peutical intervention  which  will  be  necessary. 

I  do  not  maintain  by  any  means  that  you  should 
frighten  your  patient.  That  would  be  absurd,  out  of 
place.  But,  believe  me,  you  will  defeat  the  end  which 
you  have  in  view  by  reassuring  her  too  much,  by  not  al- 
lowing her  a  certain  degree  of  vague  apprehension  which 
will  serve  you  as  a  valuable  auxiliary.  All  patients  (and 
women  more  than  others)  are  so  constituted  that  they  will 
not  be  treated  when  they  think  they  have  nothing  to 
dread,  when  they  do  not  experience  "a  little  fear"  (per- 
mit me  the  word).  Do  not  overlook  this  general  disposi- 
tion of  the  human  heart,  and  utilize  it  for  the  interest  of 
your  cause — that  is  to  say,  for  the  protection  of  the  pa- 
tient, whose  health  is  confided  to  you,  under  conditions 
so  especially  difficult  and  delicate. 


CHAPTER  XY. 

HUSBAND   SYPHILITIC  ;    WIFE   SYPHILITIC   AND    ENCEINTE. 

FouETH  order  of  cases :  Husband  sypMUtic ;  wife 
sypMlitic  and  enceinte. 

We  now  come  to  the  fourth  and  last  situation  possible. 
A  man  is  married  despite  a  syphilis  not  yet  extinct ;  he 
has  infected  his  young  wife  ;  and,  in  addition,  this  wife  is 
enceinte. 

It  would  be  superfluous  to  say  that  this  situation  is 
more  serious  than  any  we  have  previously  studied,  the 
most  prolific  in  dangers,  in  catastrophes  of  various  kinds, 
as  also  in  practical  difliculties  for  the  physician. 

What  may,  in  reality,  result  from  such  a  state  of 
things  ? 

In  the  first  place,  the  infant  procreated  in  such  con- 
ditions— that  is  to  say,  the  issue  of  a  father  and  mother 
both  syphilitic — is  subject  to  the  gravest  prognosis.  It  is 
destined,  it  may  be,  to  die  after  some  months  of  intra- 
uterine life  ;  it  may  be,  to  come  to  term  still-born  or  mori- 
bund ;  it  may  be,  to  be  born  with  the  pox. 

Of  these  three  alternatives,  let  us  concede  the  best — the 
infant  is  born  with  the  syphilis.  N"ow,  this  child  may  be 
confided  to  a  healthy  nurse,  and  you  may  be  sure  that  it 
will  transmit  the  infection  to  her — that  is  almost  inevi- 
table.    This  nurse,  in  her  turn,  may  infect  her  own  child  ; 


170     •  SYPHILIS  AND  MARRIAGE. 

may  infect  her  husband,  as  has  been  seen  so  many  times. 
Bnt  I  spare  yon  the  enumeration  of  the  possible  ricodhets 
Qti  these  last  contaminations. 

Such  is,  in  brief,  the  perspective  offered  to  us  by  this 
fourth  order  of  cases  ;  it  is,  then,  most  certainly  a  subject 
of  study  which  demands  all  our  attention.  In  the  first 
place,  I  will  reassure  you  by  saying :  The  situation  is  very 
critical,  very  serious,  assuredly ;  but  it  is  not  desperate, 
either  for  the  present,  or  a  fortiori  for  the  future. 

As  for  the  future,  the  outlook  is  not  doubtful.  For, 
treat  this  syphilitic  couple  actively,  methodically,  pro- 
tractedly, and  you  will  bring  it  about  that  they  will  have, 
later  on,  living  and  healthy  children,  exempt  from  every 
specific  phenomenon.  And,  even  as  to  the  present,  as 
regards  the  existing  pregnancy,  it  is  not  impossible — ^it 
is  not  impossible,  I  say  no  more  than  this — that  treatment 
may  avert  a  complete  disaster.  In  other  words,  it  is  not 
impossible  that  the  mother,  submitted  to  an  active  treat- 
ment during  gestation,  may  give  birth  to  a  living  and 
viable  child,  and  one  which  may  even  remain  free  from 
every  specific  accident.     Thus  : 

1.  Many  times  I  have  obtained  from  specific  medica- 
tion this  prime  and  inestimable  success — the  prevention  of 
abortion,  and  the  bringing  of  the  pregnancy  to  full  term. 
The  child  born  under  these  conditions  does  not,  it  is  true, 
escape  syphilis  ;  but  it  is  born  viable,  resisting,  capable  of 
tolerating  specific  medication,  capable,  in  a  word,  of  living 
with  the  syphilis,  and  of  being  cured  of  this  syphilis  by 
subsequent  treatment.  Examples  of  this  kind  are  so 
numerous  that  I  regard  any  particular  citation  as  super- 
fluous. 

2.  In  such  circumstances,  I  have  even  seen  children 
born  healthy,  exempt  from  every  syphilitic  symptom. 


HUSBAND  SYPHILITIG;   WIFE  8YPEILITIG— ENCEINTE.  171 

Example :  A  young  man  is  married  while  in  the  active 
secondary  period,  notwithstanding  the  advice  of  his  phy- 
sician. Five  months  later,  his  wife  becomes  enceinte. 
In  the  second  month  of  pregnancy  she  is  brought  to  me, 
and  I  discover  upon  her  specific  accidents  as  manifest,  as 
indubitable  as  possible.  I  then  treat  her  energetically, 
and  I  pursue  the  medication  with  vigor  during  the  entire 
period  of  her  gestation.  I  have  the  happiness,  first  of  all, 
of  bringing  the  pregnancy  to  full  term.  Besides,  the 
child  is  born  healthy,  well-nourished,  and  of  almost  the 
average  development.  It  continues  to  live,  and  remains 
exempt  from  all  specific  manifestations.  I  observed  it 
most  carefully  for  about  fifteen  months,  after  which  I  lost 
sight  of  it ;  and  I  can  guarantee  that  during  all  this 
period  it  did  not  present  the  least  suspicious  phenom- 
enon. 

M.  Langlebert  has  related  a  case    almost   identical. 

"Madame  X married,  in  November,  1869,  one  of  my 

patients,  whom  I  had  been  treating  for  some  months 
for  constitutional  syphilis.  She  immediately  became  en- 
ceinte., and  must  have  contracted  her  husband's  disease 
about  the  same  time.  She  had  scarcely  completed  the 
third  month  of  her  pregnancy  when  a  confluent  roseola 
covered  her  body.  Blackish  crusts  disseminated  over  the 
hairy  scalp,  a  very  pronounced  alopecia,  a  cervical  ade- 
nopathy, tonsillar  mucous  patches  of  ulcerating  form — 
everything  seemed  to  indicate  the  debut  of  a  very  severe 
syphilis  that  she  must  inevitably  transmit  to  her  infant 
— if,  indeed,  this  infant  should  see  the  light,  wMch  then 
appeared  by  no  means  probable.    I  immediately  prescribed 

for  Madame  X pills  of  the  sublimate ;    afterward  I 

submitted  her  to  the  use  of  the  iodide  of  potassium,  con- 
tinuing the  mercury  at  the  same  time.     The  pregnancy 


172     •  SYPHILIS  AND  MARRIAGE. 

followed  its  regular  course,  and  toward  the  end  of  August, 
1870,  Madame  X gave  birth  to  a.  very  smaU  but  healthy- 
girl,  which  she  nursed  herself,  according  to  my  advice. 
Now,  this  child  has  not  ceased  for  a  single  moment  to 
continue  in  good  health.  She  has  had  nothing  upon  her 
body — neither  spots,  nor  lumps,  nor  the  least  symptom  of 
suspicious  appearance.  To-day  she  is  a  little  over  two 
years  of  age  ;  she  is  large,  well  developed,  and  is  marvel- 
ously  well.  She  has,  then,  escaped  the  syphilis,  and 
this  result  she  owes  to  the  treatment,  which  could  alone 
preserve  her  from  the  infection  which  her  mother's  con- 
dition during  gestation  must  otherwise  have  rendered 
inevitable.* 

Successes  of  this  kind,  obtained  under  conditions  so 
unfavorable,  are  well  adapted,  certainly,  to  encourage  the 
physician,  and  indicate  to  him  the  line  of  conduct  to  be 
followed  in  like  circumstances. 

That  settled,  we  now  come  to  the  indications  to  be  ful- 
filled in  the  class  of  cases  which  it  remains  for  us  to  study. 
Relatively  to  the  husband,  there  is  nothing  more  simple — 
nothing  more  to  do  than  to  prescribe  for  him  the  usual 
treatment  for  the  diathesis.  But  it  is  the  wife,  especially, 
that  claims  our  solicitude  at  present.  This  wife  must  be 
treated,  and  treated  with  so  much  more  of  care,  of  method, 
of  attention,  of  vigilance,  as  she  represents  two  patients, 
if  I  may  thus  express  it,  two  beings  to  be  preserved. 
And,  indeed,  it  is  a  question  of  the  mother,  first  of  all ; 
but  it  is  no  less  a  question  of  the  infant  which  she  carries 
in  her  womb,  of  the  infant  more  endangered  than  she, 
and  which  we  can  only  reach,  only  protect,  through  her. 

To  treat  the  motJier,  then,  is  the  capital  indication  to 
be  fulfiUed. 

*  La  syphilis  dans  ses  rapports  avec  le  niariage,  p.  237. 


HUSBAND  8YPEILITI0;   WIFE  SYPHILITIC— ENGEIITTE.  1Y3 

Well,  gentlemen,  this  indication,  so  simple,  so  rational, 
and,  moreover,  so  completely  authorized  by  experience, 
you  must  not  regard  as  accepted  by  all.  It  has  its  op- 
ponents. It  has  excited  objections  ;  it  has  given  rise  to 
controversies  which  have  recently  again  agitated  one  of 
our  learned  societies. 

It  has  been  said :  "What !  This  pregnant  woman  you 
are  going  to  treat,  and  to  treat  how  ?  You  will  prescribe 
for  her  mercury  ?  But  this  mercury,  do  you  not  fear  that 
it  may  be  prejudicial  to  her  in  several  respects  ?  Will  it 
not,  in  the  first  place,  increase  and  complicate  the  gastric 
troubles  of  pregnancy  ?  Will  it  not  add  its  own  special 
angemiating  action — to  the  anaemia,  the  hydrosemia  of 
pregnancy  ?  And  especially,  a  capital  danger,  does  it  not 
involve  the  risk  of  producing  abortion  ?  For,  every  day, 
we  see  abortion  produced  in  syphilitic  women  treated  by 
mercury,"  etc. 

To  all  that,  gentlemen,  our  reply  will  be  as  direct,  as 
categorical  as  possible.  Yes,  without  doubt,  we  will  say, 
mercury  maladministered  is  open  to  such  objections. 
Yes,  without  doubt,  with  mercury  given  in  certain  forms 
or  in  certain  doses  we  may  produce  the  accidents  alluded 
to  —  that  is  to  say,  aggravate  gastric  troubles,  increase 
ansemia,  and  even  favor  or  determine  abortion.^  But  that 
is  not  the  question,  and  we  have  here  nothing  to  do  with 
the  toxic  or  industrial  use  of  mercury.  What  is  alone 
relevant  to  our  present  inquiry  is  the  safe  and  prudent 
administration  of  mercury  as  a  remedy ;  it  is  a  mercurial 
treatment  appropriate  to  the  forces  and  to  the  special  con- 
ditions of  the  patient.     I^ow,  a  treatment  of  this  kind, 

*  Vide  Ad.  Lize,  Influence  de  Vintoxication  mercurielle  lente  sur  le  produit  de  la 
conception  {Union  Medicale,  1862,  t.  i,  p.  106).  H.  Hallopeau,  Du  mercure,  action 
pJiysiologique  et  tJierapeutique  {Theses  d'agregation,  Paris,  IS'ZS). 


17i     •  SYPHILIS  AND  MARRIAGE. 

metliodically  instituted  and  supervised,  will  not  only  re- 
main innocent  of  the  dangers  which  have  been  ascribed 
to  it,  but  it  will,  moreover,  constitute  the  best  and  the 
surest  means  at  our  disposition  of  bringing  the  pregnancy 
to  term,  and  of  j)reserving  the  fcetus  in  such  a  case. 

ISTow,  let  us  enter  into  details,  and  discuss,  point  by 
point,  the  various  objections  which  precede.  The  matter 
is  worth  the  trouble,  since  the  existence  of  the  infant  is 
here  in  jeopardy,  and  depends  upon  medical  intervention 
or  non-intervention : 

I.  In  the  first  place,  as  regards  the  gastric  troubles,  ex- 
perience demonstrates  that  we  can  easily  avoid  them.  We 
should  guard  against  administering  to  our  patients  the 
sublimate,  the  biniodide,  the  syrup  of  Gibert,  or  all  other 
analogous  preparations,  which  are  badly  tolerated  by  wo- 
men in  general,  and  especially  by  women  in  a  state  of 
pregnancy.  We  should  be  careful  to  prescribe  other  mer- 
curial combinations  which  are  not  apt  to  disturb  the 
digestive  functions  to  the  same  degree.  We  should  pre- 
scribe, for  example,  the  proto-iodide,  a  milder  remedy, 
which,  in  a  medium  dose,  from  five  to  eight,  or  even  ten, 
centigrammes  daily,  is  ordinarily  well  tolerated  by  the 
stomach.  Here  we  are  accustomed  to  administer  the  pro- 
to-iodide  every  day  to  our  syphilitic  women  in  a  state  of 
pregnancy,  and,  nine  times  out  of  ten,  we  see  them  remain 
undisturbed  in  their  gastro-intestinal  functions.  Should 
it  determine,  exceptionally,  some  malaise^  some  gastric  or 
intestinal  disorder,  we  almost  always  succeed  in  causing 
it  to  be  tolerated  by  some  expedient  or  another ;  it  may 
be  by  giving  it  before  or  during  the  meals ;  it  may  be 
by  associating  with  it  a  small  dose  of  opium ;  it  may  be 
by  prescribing  some  digestive  adjuvant,  such  as  wine  of 
quinquina,  wine  of  gentian,  coffee,  etc.     If,  however,  the 


HUSBAND  8YPEILITI0;   WIFE  STPEILITIO— ENCEINTE.  175 

stomacli  still  shows  itself  rebellious  to  tliis  remedy,  if 
gastric  or  intestinal  troubles  continue  to  be  occasioned  by- 
it,  there  always  remains  a  resource  by  which  the  patient 
may  enjoy  the  benefit  of  a  mercurial  influence  without  in- 
jury to  the  digestive  functions.  This  resource  you  have 
anticipated  in  advance  :  it  is  the  resort  to  mercurial  fric- 
tions^ a  mode  of  treatment  whose  energetic  action  needs 
no  longer  to  be  demonstrated  in  a  general  manner,  and 
which  has  been  highly  extolled  in  a  special  manner  by 
some  physicians  as  peculiarly  adapted  to  syphilitic  wo- 
men during  the  state  of  gestation. 

II.  The  second  objection  is  altogether  theoretical. 
JS'ever,  for  my  part,  have  I  seen  the  ansemia  of  pregnancy 
increased  under  the  influence  of  a  mercurial  treatment  in- 
telligently conducted.  And  as  to  the  special  ansemia  of 
syphilis,  it  is  now  well  demonstrated  that  it  has  its  true 
remedy  in  mercury.  It  has  been  said,  with  all  reason, 
that  from  the  point  of  view  of  the  phenomena  of  specific 
ansemia,  "  le  mercure  est  lefer  de  la  mrole.'''' 

III.  Finally,  it  is  absolutely  false  that  mercury  pro- 
motes abortion  in  syphilis,  as  certain  physicians  contend. 
From  the  fact  that  it  is  not  rare  to  see  syphilitic  women 
abort  during,  or  at  the  termination  of,  a  mercurial  course 
of  treatment,  it  has  been  inferred  that  the  abortion  is  due 
to  the  mercury  in  such  case.  This  induction  is,  in  truth, 
very  illegitimate ;  it  is  even,  I  would  say,  devoid  of  all 
foundation,  for  it  disregards  a  factor  more  than  essential 
in  this  matter,  viz.,  the  disease  itself,  syphilis.  It  attrib- 
utes to  tlie  treatment  that  which  is  the  result  of  the  dis- 
ease. It  is  needless  to  remind  you  again  that  syphilis 
causes  a  most  powerful  predisposition  to  abortion  ;  there 
are  few  morbid  states  that  may  be  comparable  to  it  from 
this  point  of  view,  and  that  furnish  so  considerable  a 


176   -  SYPHILIS  AND  MARRIAGE. 

contingent  to  the  sum  total  of  abortions.*  So  that, 
when  a  syphilitic  woman,  submitted  to  a  mercurial 
treatment,  comes  to  have  a  miscarriage,  one  is  justified 
in  attributing  this  miscarriage,  not  to  the  influence  of 
mercury,  but  to  the  exclusive  influence  of  the  specific 
diathesis. 

Do  you  wish  the  proof  of  this  ?  This  proof  may  be 
found  in  these  two  results  of  clinical  experience,  viz.  : 

1.  That  numbers  of  syphilitic  women  abort  without 
ever  having  taken  an  atom  of  mercury.  The  frequency  of 
this  first  fact  is  notorious. 

2.  That  numbers  of  syphilitic  women,  who,  without 
treatment,  have  had  a  series  of  miscarriages,  succeed  in 
carrying  a  pregnancy  to  full  term  only  after  having  un- 
dergone a  mercurial  treatment.  This  is  a  point  upon 
which  I  have  insisted  at  length  in  a  preceding  chapter, 
and  which  it  will  be  suflicient,  I  think,  to  simply  enunci- 
ate again  without  more  ample  development. 

So  the  opinion  which  considers  mercury  a  cause  of 
abortion  in  syphilis  should  not  prevail  against  what  I 
would  call  clinical  evidence — that  is  to  say,  against  the 
imposing  mass  of  clinical  facts,  which,  collected  from  all 
sides,  related  by  observers  exercising  their  art  in  the 
most  different  quarters,  all  accord,  nevertheless,  not  only 
in  exculpating  mercury  from  this  special  accusation, 
but  also  in  presenting  it  as  the  best  safeguard  that  we 
possess  against  the  abortive  tendencies  of  syphilis.  This 
opinion  I  energetically  condemn ;  for  my  part,  I  do  not 
hesitate  to  characterize  it  as  mischievous,  in  fact,  for  it 
has  as  a  logical    consequence  the    privation  of    syphi- 

*  I  may  be  permitted,  in  this  connection,  to  refer  the  reader  to  a  chapter  of  my 
Lcfons  sur  la  syphilis  etudiee  plus  particulieremeni  chez  la  femme,  p.  955.  Vide  also 
"  Illustrative  Cases,"  Note  I. 


HUSBAND  SYPHILITIC;   WIFE  SYPHILITIO— ENCEINTE.  177 

litic  women  in  the  state  of  gestation  from  the  benefit 
of  a  potent  remedy,  which  is  equivalent  to  the  surest 
means  of  condemning  them  to  the  probable  chances  of 
abortion. 

For  the  rest,  there  is  to-day,  with  very  rare  exceptions, 
an  agreement  upon  this  question ;  and,  without  insisting 
further,  I  will  summarize,  what  may  be  called  the  present 
state  of  science  relative  to  this  subject,  by  formulating  the 
two  following  propositions  : 

1.  Mercury  does  not  always  prevent  abortion  in  syph- 
ilitic women,  but  nothing  demonstrates  that  it  has  ever 
contributed  to  its  production,  at  least  when  administered 
in  therapeutic,  non-excessive,  non-toxic  doses. 

2.  It  often  succeeds  in  a  very  evident  manner  in  pre- 
venting abortion,  in  prolonging  pregnancy,  in  conducting 
it  to  its  normal  term.*    In  practice,  then,  when  we  meet 


*  What  authorities  could  I  not  quote  here !  Let  me  cite  at  hazard :"....! 
should  be  disposed  to  place  syphilis  among  the  most  frequent  causes  of  abortion. 
.  .  .  We  may,  nevertheless,  be  quite  sure  of  destroying  this  cause  of  abortion  as 
soon  as  we  are  able  to  recognize  it.  Mercury  properly  administered  almost  always 
succeeds.  .  .  .  We  commonly  fear  to  have  recourse  to  mercury  during  pregnancy, 
because  we  imagine  that  it  may  cause  abortion.  But  a  large  experience  has  con- 
vinced me  that  this  opinion  is  devoid  of  all  foundation,  and  that,  with  prudence, 
we  may  administer  mercury  in  doses  sufficient  to  cure  all  the  symptoms  of  syphilis 
during  the  entire  period  of  pregnancy,  without  any  injury  to  the  mother  and  the 
child.  .  .  .  When  a  pregnant  woman  is  evidently  attacked  with  syphilis,  or  when 
I  have  strong  reasons  to  believe  Ker  infected,  I  never  hesitate  to  make  use  of  this 
great  remedy.  This  course  has  always  appeared  to  me  advantageous." — Benjamin 
Bell,  "  Treatment  of  Virulent  Gonorrhoea  and  of  Venereal  Diseases "  (trans,  of 
Brosquillen,  t.  ii,  p.  608). 

"  Gestation,  so  far  from  contraindicating  the  employment  of  energetic  treat- 
ment, demands  still  more  attention  and  intelligent  promptitude.  I  have  seen 
many  more  abortions  in  syphilitic  women  not  treated  than  in  those  who,  taken 
in  time,  have  been  subjected  to  a  methodic  medication." — Ricord,  Traife  pratique 
des  maladies  vineriennes,  1838.  That  which  M.  Ricord  intends  by  a  "methodic 
medication  "  is  none  other  than  the  usual  treatment  of  syphiHs  with  mercury. 

"  The  mercurial  treatment  is  regarded  at  Lourcine  as  the  preservative  against 
abortion  "  (Coffin,  work  cited). 

"  Administered  properly,  mercury  is  the  most  powerful  preservative  for  the 


178  SYPHILIS  AND  MARRIAGE. 

with,  a  sypliilitic  woman  in  a  state  of  pregnancy,  our  first 
care  should  be  to  submit  her  to  specific  treatment.  And 
if  this  woman — as,  indeed,  is  the  case  in  the  class  of 
situations  Avhich  we  are  now  studying — is  affected  with 
a  syphilis  still  recent,  demanding  the  employment  of 
mercury,  we  should  not  hesitate  to  prescribe  mercury. 
We  should  prescribe  it,  without  doubt,  in  moderate 
doses,  appropriate  to  the  patient's  strength  and  gas- 
tric tolerance ;  but  we  should  prescribe  it  in  an  active, 
.sustained,  prolonged,  veritably  efficacious  manner,  suf- 
ficient, in  a  word,  to  accomplish  the  object  we  have  in 
view. 

And  this  treatment,  gentlemen — I  do  not  fear  to  repeat 

infant;  and,  as  M.  Vannoni  has  established  (i7  raccogJ.  mcd.,  August,  1872),  if  it 
does  not  prove  itself  a  preventive  of  abortion,  it  is  because  it  is  not  given  early 
enough  or  for  a  sufficiently  long  time.  There  is  an  urgent  necessity  of  taking 
pregnancy  into  consideration  in  the  therapeutics  of  syphilis,  since  we  have  seen  a 
mercurial  treatment  administered  to  pregnant  women  preserve  the  infants  born 
in  the  earlier  confinements,  and  allow  the  disease  to  destroy  those  of  later  preg- 
nancies when  treatment  was  omitted." — Rollet,  Traite  des  maladies  vmericnnes, 
Paris,  1865. 

"  The  dangers  of  giving  mercurial  preparations  to  enceinte  women  have  been 
much  exaggerated ;  it  is  now  recognized,  on  the  contrary,  that  they  render  immense 
service  when  syphilis  has  been  the  suspected  cause  of  former  abortions,  for  the  dis- 
ease may  rest  latent  in  the  mother,  or  attack  the  foetus  only.  It  is  doubtless  in 
Buch  cases  of  obscure  cause  that  Young,  Beatty,  and  Russel,  in  England,  have  ob- 
tained successes  of  which  they  refer  all  the  honor  to  mercury." — Devilliers,  article 
Avortement  in  the  Nouvcau  diclionnaire  de  medccine  et  de  clditirgie  prcdiqucs,  t. 
iv,  p.  323. 

"  Without  any  doubt,  the  administration  of  mercury,  of  the  iodide  and  of  other 
medicaments  which  contain  a  toxic  principle,  when  carried  to  the  point  of  produc- 
ing a  sort  of  chronic  intoxication,  is  a  powerful  cause  of  abortion,  and  the  cases 
of  abortion  attributed  to  mercury  are  not  all  from  errors  of  interpretation.  .  .  . 
But  it  is  no  less  true — and  observation  confirms  it  every  day  to  every  mind  divested 
of  preconceived  ideas — that  a  treatment  during  pregnancy  by  mercury  or  by  any 
other  active  agent  in  order  to  combat  syphilitic  symptoms,  to  destroy  the  diathesis, 
or  build  up  the  constitution,  so  far  from  being  a  danger,  is,  on  the  contrary,  an 
advantage  both  for  the  mother  and  for  the  infant,  if  this  treatment  be  directed 
with  prudence,  and  given  in  moderate  doses." — Jacquemier,  article  AvorlemciU,  in 
the  Diclionnaire  encyclopedique  des  sciences  medicalcs,  t.  vii,  p.  539. 


HUSBAND  SYPHILITIC;  WIFE  SYPHILITIC— ENGEINTE.  179 

it  again  in  conclusion — we  should  institute  with  so  much 
more  of  care,  we  should  supervise  with  so  much  more  of 
method,  of  solicitude,  of  vigilance,  because  it  is  not  a 
question  of  only  one  patient  to  be  cured,  but  because 
with  this  patient  and  through  her  there  is  another  exist- 
ence to  be  preserved,  that  of  the  infant  which  at  this 
period  intimately  shares  its  mother's  destinies. 


CHAPTER  XVI. 

DANGERS   TO   SOCIETY — SOCIAL   PEOPHTLAXIS. 

We  have  jnst  passed  in  review  tlie  four  different  situa- 
tions whicli  may  be  presented,  when  syphilis  has  been  in- 
troduced into  a  household  by  a  syphilitic  husband.  And 
apropos  of  each  of  these  situations,  I  have  endeavored  to 
trace  out  for  you  the  line  of  conduct  to  be  followed  by 
the  physician,  and  determine  the  numerous  indications 
which  it  is  incumbent  upon  us  to  fulfill  under  such  cir- 
cumstances. 

Our  subject,  nevertheless,  is  not  altogether  exhausted. 
An  essential  and  most  practical  point  remains  for  me  to 
mention  to  you  ;  and  with  it  we  will  terminate  our  present 
lecture. 

This  point  relates  to  a  veritable  social  duty  (you  will 
see  that  there  is  no  exaggeration  in  this  word),  which 
is  imposed  upon  the  physician  in  the  particular  circum- 
stances which  we  have  just  been  considering — a  duty  at 
once  manifest  and  undeniable,  and  the  accomplishment 
of  which  is  fruitful  in  useful  results,  but,  nevertheless,  a 
duty  often  omitted,  neglected,  violated  even,  in  ordinary 
practice,  to  the  great  detriment  of  those  whom  it  is  our 
professional  mission  to  protect. 

The  greater  number  of  our  classic  treatises  remain  ab- 
solutely silent  upon  the  question  which  is  about  to  follow. 


DANGERS  TO  SOCIETY— SOCIAL  PE0PHYLAXI8.     181 

You  will  permit  me,  then,  to  treat  it  somewhat  in  detail, 
in  order  to  show  you  its  importance  and  practical  diffi- 
culties. 

When  syphilis  has  contaminated  a  husband  and  wife 
there  is  a  great  risk,  as  we  have  previously  shown,  of 
their  child  being  born  tainted  with  syphilis.  Now,  this 
infant,  supposing  it  to  be  syphilitic,  evidently  carries  with 
it  the  dangers  of  contagion.  That  is  to  say,  it  is  possible 
that  the  syphilis  with  which  it  is  affected  may  radiate 
from  it  to  the  persons  who  surround  it,  who  are  called 
upon  to  take  care  of  it,  and  who,  in  various  ways,  come 
in  contact  with  it. 

Well,  then — and  this  is  the  point  to  which  I  wish  to 
direct  your  attention — what  will  happen  should  this  in- 
fant be  confided  to  a  nurse  ?  The  answer  is  easy :  almost 
infallibly  this  child  will  infect  the  nurse.  It  is  thus,  then, 
that  syphilis  proceeds  from  the  family  of  the  infant  and 
attacks  persons  outside.  First  misfortune,  first  deplora- 
ble consequence  of  the  situation  which  now  occupies  us. 

But  this  is  not  all.  You  know,  since  you  have  often- 
times heard  me  repeat  it,*  what  a  singular  faculty  of 
expansion,  of  irradiation,  the  syphilis  of  nurslings  and 
nurses  presents,  which  propagates  or  may  propagate  it- 
self by  a  series  of  unexpected  ricochets  in  such  a  way 
as  to  constitute  a  source  of  multiple  contaminations. 
How  many  times,  for  example,  has  it  not  happened  that 
a  syphilitic  nursling  has  infected  many  persons  of  its  en- 
tour  age,-\  or,  indeed,  that  a  nurse  infected  by  a  syphilitic 

*  Nourrices  el  nourrissons  sypliiliiigues,  Paris,  18*78. 

f  Example  of  the  kind :  A  nurse  infected  with  syphilis  conaes  into  a  young 
family,  whose  infant  is  confided  to  her.  She  infects  this  child.  The  nature  of  the 
morbid  symptoms  remains  unrecognized  at  first,  as  would  almost  necessarily  be  the 
case,  so  that  no  precautions  are  taken  against  the  possible  dangers  of  such  a  contam- 
ination. What  happens  ?  The  infant,  on  its  part,  infects — 1.  Its  mother ;  2.  Its  grand- 
'  13 


182    -  SYPHILIS  AND  MAERIAGE. 

infant  has  transmitted  the  disease  to  her  own  child,  to  her 
own  husband,  to  a  strange  nursling?  And  how  many- 
times,  also,  has  not  each  one  of  these  new  contagions  be- 
come, in  its  turn,  the  origin  of  other  contagions  ? 

The  cases  in  which  these  cascades  of  contagion  are 
produced,  if  I  may  thus  speak,  primarily  originating  from 
the  syphilis  of  a  new  -  born  child,  abound  and  super- 
abound.  AVithout  exaggeration,  they  literally  swarm  in 
medical  literature.  I  have  already  cited  a  great  number 
of  them  when  giving  you  the  history  of  the  syphilis  of 
nurses  and  nurslings.  Allow  me  to  briefly  recall  to 
you,  as  types  of  this  Mnd,  the  three  following  cases : 

1.  A  young  man  afl'ected  with  syphilis  marries  prema- 
turely. He  immediately  infects  his  wife.  A  child  born 
of  this  marriage  is  confided  to  a  nurse,  and  infects  this 
nurse.     She,  in  her  turn,  transmits  the  syi^hilis  to  her 

mother;  3  and  4.  Two  uursery-maids  of  the  family,  girls  of  absolutely  irreproach- 
able character.  Aud  the  young  wife  transmits  the  contagion  to  her  husband  some 
months  later. 

I  have  often  said  that  nofhhiff  is  so  dangerous  to  the  persons  surrounding  it 
as  a  syphililic  infant.  The  thousand  attentions  which  the  new-born  requires  in 
its  raising — the  kisses,  the  caresses,  which  are  lavished  upon  it — serve  as  the 
origin  of  easy  and  frequent  contaminations.  I  have,  in  my  notes,  to  speak  only 
of  cases  observed  by  myself,  a  dozen  cases  of  contagions  of  this  order.  It  is 
thus,  for  example,  that  a  grandmother,  sixty-five  years  of  age,  was  infected  by  her 
little  grandson  that  she  fed  with  a  spoon,  having  taken  the  pains  to  carry  each 
spoonful  to  her  mouth  before  giving  it  to  the  child ;  the  virus  was  certainly  trans- 
mitted in  this  case  from  the  lips  of  the  infant  to  those  of  the  grandmother.  Like- 
wise, I  now  have  under  my  care  a  young  woman  who  was  infected  by  her  child, 
which  had  been  infected  by  a  nurse.  My  learned  colleague,  M.  Hillairet,  has 
recounted  to  me  the  following  case :  A  young  man  affected  with  syphilis  marries 
prematurely,  and  soon  infects  his  wife.  A  child  born  of  this  couple  presents  the 
accidents  of  hereditary  syphilis  several  weeks  later,  and  infects  its  nurse.  Con- 
fided then  to  its  maternal  grandparents,  it  transmits  the  contagion  to  both  of 
them  by  the  intermediary  of  a  nursing-bottle.  The  grandfather  and  the  grand- 
mother had  the  habit  of  putting  the  nursing-bottle  to  their  lips,  and  that  with- 
out taking  the  precaution  to  wipe  it  after  it  came  from  the  mouth  of  the  child. 
Now,  the  child  being  affected  with  labial  syphilides,  both  were  infected  in  the 
mouth,  and  presented  an  indurated  labial  chancre,  soon  followed  by  general  ac- 
cidents. 


DANGERS  TO  SOCIETY— SOCIAL  PROPHYLAXIS.     183 

own  child,  in  tlie  first  place ;  then,  to  another  nursling ; 
then,  two  months  later,  to  her  husband.* 

2.  A  syphilitic  child,  born  in  an  apparently  healthy 
condition,  is  confided  to  a  nurse,  whom  it  soon  infects. 
This  nurse,  who  is  nursing  another  child  at  the  same  time, 
infects  this  child,  which  soon  dies.  She  then  takes  a 
third  nursling,  which,  in  its  turn,  contracts  the  syphilis 
and  dies.  Another  nurse,  a  friend  of  the  former,  having, 
through  kindness,  given  the  breast  to  this  last  child,  re- 
ceives the  syphilis  from  it.    She  then  infects  her  nursling. 

Please  remark,  gentlemen,  this  makes  five  contagions 
from  this  syphilis,  and  two  deaths. 

3.  Another  example,  related  by  one  of  our  most  dis- 
tinguished colleagues — M.  le  Dr.  Dron  (of  Lyons) :  A 
syphilitic  child  infects  its  nurse.  This  nurse,  in  order  to 
empty  her  breast,  suckles  three  nurslings — all  three  of 
which  take  syphilis.  Each  of  these  children  infects  its 
mother ;  each  of  these  three  mothers  infects  her  husband,  f 
Count  again  :  ten  syphilitic  contaminations  derived  par 
ricocliet  from  the  syphilis  of  a  nursling !  And  do  they 
stop  here  %  % 

It  is  useless  to  add,  moreover,  from  another  point  of 
view,  what  you  well  appreciate,  what  goes  without  saying, 
viz.,  that  a  syphilis  derived  from  such  an  origin  has  every 
chance  of  remaining  unrecognized,  at  least  during  a  cer- 
tain time ;   and,  in  consequence  of  being  abandoned  to 

*  Vide  "  Illustrative  Cases,"  Note  V. 

f  Achille  Dron,  Mode  particulicr  de  transmission  de  la  sypliilis  au  nourrisson par 
la  nourrice  dans  Vallaitemcnt,  Lyon,  IRVO. 

\  Sometimes  even  (but  this  is  only  exceptional,  it  is  true)  similar  cascades  of 
contagion  have  made  a  still  more  considerable  nimiber  of  victims.  Thus,  one  has 
seen  a  syphilitic  nurse,  going  into  a  small  village,  transmit  syphilis  to  sixteen, 
eighteen,  twenty-three  persons,  and  become  the  origin  of  a  small  local  epidemic 
{vide  Amilcare  Ricordi,  Sifilide  da  allattamenio  e  forme  iniziali  della  sijilide,  Milan, 
1863). 


184  SYPHILIS  AND  MARRIAGE. 

itself,  left  without  treatment.  Also,  tliat  it  can  not  fail, 
and  does  not  fail,  in  numbers  of  cases,  to  result  in  veri- 
table catastrophes — it  may  be,  for  example,  in  the  death 
of  the  nurslings  contaminated  by  their  nurses  ;  it  may  be 
in  serious  accidents  developed  upon  the  nurse,  or  upon 
other  iDersons  who  have  been  the  victims  of  such  conta- 
gions.* 

Now,  to  return  to  our  subject,  gentlemen,  it  is  pre- 
cisely dangers  of  this  kind  which  the  physician  ought  to 
foresee,  when  he  finds  himself  in  a  position  to  prevent 
them.  He  recognizes  these  dangers  ;  he  knows  that  they 
will  occur  if  he  does  not  interfere ;  it  is  his  business, 
then,  to  interfere  in  order  to  avert  them.  And  here  be- 
gins for  him  an  actual  duty,  which,  without  exaggeration, 
I  have  already  characterized  as  a  social  duty,  since  it 
has  for  aim  and  for  result  the  protection  of  the  interests 
of  society.  This  duty,  I  do  not  hesitate  to  say,  is  im- 
posed upon  the  pliysiciany  who  would  be  culpable  in 
neglecting  it,  in  divesting  himself  of  it ;  by  so  much  more 
as,  in  fulfilling  it,  he  mil  at  the  same  time  satisfy  the  in- 
terests of  Ms  patient. 

This  principle  stated,  let  us  come  to  its  application  : 
To  circumscribe  the  pox  in  its  original  bed  so  as  to 

*  Here  are  examples  of  the  kind,  selected  from  many  others : 

1.  An  infant,  born  of  a  syphilitic  father,  is  confided  to  a  healthy  nurse.  It 
soon  presents  various  syphilitic  accidents  and  infects  its  nurse.  She,  in  her  turn, 
infects  her  husband.  The  husband  is  affected  with  an  iritis  and  loses  one  eye.  The 
wife  is  attacked  some  years  later  with  a  syphilitic  paralysis,  to  which  she  suc- 
cumbs (Dr.  Delore  de  Lyon). 

2.  One  of  my  syphilitic  patients  marries,  in  spite  of  me,  and  transmits  the 
syphilis  to  his  wife  soon  after  his  marriage.  A  child  is  born,  which  (without  my 
knowledge,  it  is  needless  to  say)  is  confided  to  a  nurse.  This  child  soon  presents 
numerous  symptoms  of  syphilis,  and  infects  the  nurse.  This  woman,  in  her  turn, 
infects — 1.  Her  child,  which  dies  in  some  months ;  2.  Her  husband ;  affected  with 
a  severe  iritis,  he  loses  an  eye.  A  year  later,  she  is  delivered  of  an  infant  which 
presents  grave  accidents  of  syphilis,  and  dies  at  the  age  of  two  months. 


DANGERS  TO  SOCIETY— SOCIAL  PROPHYLAXIS.     185 

prevent  the  spread  of  its  ravages  outside,  sucli  is  the  ob- 
ject to  be  realized.     Now,  how  attain  this  ? 

For  this  there  is  bnt  one  practical  means :  it  is  to  so 
arrange  that  the  syphilitic  infant,  the  first  origin  of  the 
dangers  which  we  are  seeking  to  avert,  remains  in  the 
family,  and  is  suckled  by  its  motlier. 

It  is  evident  that,  if  it  does  not  leave  the  paternal 
hearth,  if  it  receives  its  mother's  breast,  there  will  be  no 
opportunity  of  its  transmitting  to  a  nurse  and  to  other 
persons  the  dreadful  contagion  of  which  it  bears  the 
germ. 

It  is,  then,  to  this  object  that  the  physician  should 
direct  his  efforts.  He  must,  by  his  influence,  by  his  ad- 
vice, by  his  moral  authority,  arrange  a  situation  which 
will  protect  the  interests  of  all,  and  not  allow  a  different 
arrangement,  prejudicial  to  all,  to  be  organized  indepen- 
dently of  him.     It  is  necessary,  to  speak  clearly — 

1.  That  the  new-born  child,  the  offspring  of  syphilitic 
parents,  be- retained  under  the  roof  where  it  was  born,  so 
that  he  may  watch  over  this  child,  treat  it,  if  necessary, 
and  suppress  as  quickly  as  possible  the  contagious  acci- 
dents which  may  arise. 

2.  And  especially  is  it  necessary  that  he  oppose  with 
an  his  might  this  child  being  confided  to  a  nurse ;  he 
must  make  the  family  accept,  as  an  absolute,  unavoidable 
necessity,  the  nourishment  of  this  infant  from  the  mater- 
nal bosom. 

Let  us  now  come  to  the  practical  point.  In  brief, 
what  is  to  be  done  in  order  to  attain  this  result  % 

This  :  At  a  favorable  moment,  when  the  pregnancy  of 
the  mother  is  so  far  advanced  as  to  permit  the  hope  of  an 
accouchement  at  term,  to  address  yourself  to  the  husband, 
and  explicitly  expose  the  situation  to  him,  with  all  the 


186  SYPHILIS  AND  MARRIAGE. 

dangers  it  involves — to  say  to  Mm  tliat  his  prospective 
infant  runs  the  serious  risks  of  hereditary  syphilis;  to 
make  him  comprehend  that  under  these  circumstances 
the  child  should  not  be  intrusted  to  a  nurse,  who  would 
almost  inevitably  receive  the  contagion  ;  to  unfold  to  him, 
without  reservation,  all  the  consequences  of  such  a  con- 
tagion—  the  just  and  outspoken  recriminations  of  the 
nurse,  a  scandalous  exposure,  a  possible  lawsuit,  humili- 
ating publicity,  etc.  ;  to  conclude,  finally,  with  the  abso- 
lute obligation  imposed  upon  the  mother  to  nurse  her 
child,  the  sole  moral  expedient,  proper,  and  at  the  same 
time  efficacious,  which  can  retrieve  the  situation. 

"Then,"  you  will  add,  "arrange  it,  sir,  that  your  wife 
shall  nurse  this  infant.  The  interests  of  all — yours  and 
your  infant's — depend  upon  this.  Accept  it  as  an  abso- 
lute obligation,  as  an  indispensable  necessity,  considering 
the  circumstances  under  which  you  are  placed.  There- 
fore, if  your  wife  contemplates  nursing  it,  do  not  dissuade 
her  from  it.  And,  if  she  is  not  disposed  to  do  so,  antici- 
pate her  objections,  and  endeavor  by  all  the  means  which 
you  can  bring  to  bear  to  modify  her  resolution.  For, 
from  every  consideration,  I  again  repeat  it  to  you,  it  is 
she  and  she  alone  who  ought  to  act  as  nurse  for  your 
infant." 

By  thus  stating  the  situation,  it  will  be  rare,  indeed, 
that  the  physician  does  not  accomplish  the  purpose  he 
has  in  view.  Consequently,  his  object  will  be  realized ; 
the  infant,  syphilitic,  or  suspected  of  syphilis,  will  remain 
in  the  family,  and  will  be  nursed  by  its  mother,  and  thus 
obviate  danger  to  others.'^ 

*  If  I  had  not  considered  at  length  this  subject  in  another  work,  I  would  in- 
sist here  upon  numerous  practical  details  which  I  pass  in  silence.  It  appears 
to  me  indispensable,  nevertheless,  to  add  to  the  foregoing   some   considerations 


DANGERS  TO  SOCIETY— SOCIAL  PROPHYLAXIS.     187 

Kow,  tMs  result,  gentlemen,  do  not  doubt  it,  will  be  a 
considerable,  ca-pital  service  rendered  to  public  prophy- 
laxis. To  be  convinced  of  this,  recall  wliat  I  liave  else- 
where demonstrated  in  tracing  the  history  of  the  syphilis 
of  nurses  and  nu.rslings.  Recall  the  frequency  of  these 
contagions  transmitted  by  nursing  ;  recall  the  disastrous, 
lamentable  consequences  which  result   from  them,   the 

relative  to  a  point  of  especial  importance.  I  will  borrow  them  from  my  Le^oois  sui- 
tes nourrices  ei  les  nourrissons  syphUitiques  (Paris,  1878). 

"  ....  Do  not  hope,  gentlemen,  that  your  advice  to  confide  the  nursing  to 
the  mother  will  always  be  accepted  without  opposition.  Without  speaking  of  rea- 
sons which  do  not  exist,  of  reasons  based  upon  pretended  conveniences,  upon 
society,  or  other  considerations,  it  will  often  be  objected  that  the  mother  '  is  too 
feeble  to  nourish  it,'  that  she  could  not  endure  the  fatigues  of  nursing  without 
danger  to  herself,  etc.  Insist  (for  it  is  quite  rare  that  a  mother  can  not,  at  least 
for  some  months,  nurse  her  child) — insist,  and  say  this,  '  It  may  be  that  the  mother 
can  not  nourish  it  as  long  as  an  infant  ought  generally  to  be  nursed,  but  she  should 
do  what  is  possible,  and  that  is  all  we  ask  of  her.  Let  her  give  it  the  breast  dur- 
ing the  first  months ;  that  will  enable  us  to  form  an  opinion,  and  we  will  advise 
after  that  time.  At  all  events,  there  is  an  urgent  necessity  that  the  mother  nurse 
it  during  some  months.'  And  wherefore  this,  gentlemen  ?  Wherefor  require  at 
least  these  few  months  of  maternal  nourishment  ?  It  is  that  when  infantile  syphi- 
lis must  reveal  itself,  it  does  reveal  itself,  if  not  always,  at  least  almost  always,  with- 
in the  first  two  or  three  months.  In  158  cases,  M.  Diday  has  seen  it  break  out  146 
times  within  this  period.  Such  figures  have  such  a  significance  that  we  may  dis- 
pense with  all  commentary. 

"  Then  these  few  months  of  maternal  nursing  may  serve  us  as  a  criterion  of  the 
health  of  the  infant,  and  as  a  gidde  for  our  subsequent  action. 

"And,  in  effect — 1.  If  within  this  period  of  time  syphilis  reveals  itself  in  the 
infant,  all  is  said.  The  infant  must  undergo  the  common  lot  of  all  syphilitic  in- 
fants. In  any  case,  it  may  not  be  confided  to  a  nurse,  and  it  is  essential  to  know 
this  from  the  point  of  view  of  general  prophylaxis. 

"  In  this  first  alternative,  either  the  maternal  nursing  should  be  prolonged,  if 
that  be  possible,  or  else  we  shall  be  compelled  to  have  recourse  to  the  special  pro- 
cedures that  I  have  previously  indicated  to  you  as  being  able  to  serve  for  the  rais- 
ing of  syphilitic  children  (recourse  to  a  syphilitic  nurse,  alimentation  from  a  goat- 
nurse,  etc.).  2.  But,  if,  on  the  contrary,  after  three  months,  or,  better  still,  after 
four  or  five  months,  of  observation,  nothing  suspicious  occurs  upon  the  infant, 
there  are  strong  presumptions  (I  say  presumptions,  and  nothing  more)  that  it  may 
have  escaped  the  hereditary  influence,  that  it  may  not  be  syphilitic.  And  here  we 
are  more  at  liberty  in  our  movements  ;  for,  in  case  the  mother  is  unable  to  continue 
giving  it  the  breast,  nourishment  by  a  nurse  may  be  permitted — not,  however,  with- 
out still  subjecting  the  nursling  to  a  surveillance  close  and  minute,  sufficient  to 
prevent  all  risk  of  contagion." 


188  SYPHILIS  AWD  MARRIAGE. 

physical  catastrophes  which  they  may  entail,  the  moral 
miseries  which  they  may  expose  to  publicity,  the  scanda- 
lous actions  at  law  which  they  sometimes  give  rise  to, 
the  humiliation  and  the  shame  which  they  cause  in  fami- 
lies, etc. 

In  all  respects,  then,  it  is  important  that  the  physician 
— whenever  he  can  do  so,  and  he  often  can — should  curb 
such  contagions,  by  circumscribing  the  pox  in  its  original 
home,  by  preventing  it  from  carrying  its  dangerous  pollu- 
tions elsewhere.  This  is  for  him  a  professional  obligation 
in  relation  to  society,  an  obligation  in  which  he  should 
not  fail. 

But  I  foresee  an  objection :  "Be  it  so,"  you  are,  per- 
haps, about  to  say  to  me  ;  "we  comprehend  perfectly  the 
importance  to  society,  to  everybody,  of  thus  circumscrib- 
ing the  pox  in  its  home,  and  we  grant  you  that  the  means 
proposed  by  you  favors  this  end  in  a  measure.  Neverthe- 
less, if  this  means  has  for  its  undeniable  result  the  pre- 
vention of  the  spread  of  the  contagion  outside  of  its  home 
in  a  family,  is  it  not  defective,  dangerous  even,  from  other 
points  of  view?  'Thus,'  you  say  to  us,  'let  the  child  be 
nursed  by  its  mother.'  But  what  will  haj^pen  from  this 
procedure  if  the  mother  is  syj)hilitic  and  the  child  healthy ; 
or,  conversely,  if  the  mother  is  healthy  and  the  child  syph- 
ilitic ?  Will  not  the  contagion  be  then  transmitted  from 
the  mother  to  the  child,  or  from  the  child  to  the  mother  ? 
Will  not  this  syphilitic  mother  infect  this  healthy  child  ? 
Or,  indeed,  will  not  this  healthy  mother  be  infected  by 
this  syphilitic  child  ? " 

The  objection,  I  recognize,  has,  indeed,  its  value — at  least 
apparently.  Let  us  discuss  it,  then,  with  all  the  care  which 
it  merits,  in  order  not  to  leave  any  reservation,  any  uncer- 
tainty in  your  minds  in  relation  to  that  which  precedes. 


BANGERS  TO  SOCIETY— SOCIAL  PROPHYLAXIS.     189 

Four  orders  of  cases  are  possible  in  the  situation  we 
are  now  considering.     Thus  : 

1.  Either  the  mother  and  the  child  have  both  escaped 
the  dangers  of  the  paternal  syphilis — that  is  to  say,  remain 
healthy. 

2.  Or  the  mother  and  the  child  have  both  received 
the  infection  emanating  from  the  father — that  is,  have 
become  syphilitic. 

3.  Or,  the  mother  remains  healthy,  while  the  child  has 
undergone  the  contamination. 

4.  Or  else,  finally  and  conversely,  the  mother  is  syphi- 
litic, while  the  child  remains  healthy. 

There  we  have — have  we  not? — the  four  alternatives, 
and  the  four  only  alternatives,  which  can  or  could  be  pre- 
sented. Besides  these,  there  is  none  other  to  be  supposed, 
to  even  be  imagined  theoretically'. 

ISTow,  let  us  consider  each  of  these  in  detail,  and  see, 
apropos  of  each,  what  may  be  the  dangers  of  maternal 
nursing,  either  for  the  mother  or  for  the  child — a  discus- 
sion which  may,  perhaps,  seem  to  you  somewhat  long 
and  monotonous,  but  which  is  indispensable  to  the  clear 
understanding  of  our  subject.  , 

First  hypothesis  :  The  mother  and  the  child  have  both 
escaped  the  infection. 

In  this  case,  quite  evidently,  there  is  nothing  to  fear 
for  either  the  one  or  the  other  ;  for,  according  to  the 
proverb,  '■'■qui  n^a  Hen  ne  donne  rieny  The  nursing  of 
the  child  by  the  mother  involves  no  danger,  then,  in  any 
respect.     Let  us  pass  it  by. 

Second  hypothesis :  The  mother  and  child  are  both 
syphilitic. 

Here,  again,  there  is  no  possible  danger  of  contagion. 
The  mother  and  the  child,  both  having  syphilis,  have  no- 


190    .  SYPHILIS  AXD  MARRIAGE. 

tiling  to  fear  from  each  other ;  for  syphilis  does  not 
duplicate  itself ;  it  is  not  twice  acquired.  Let  us  even  say 
that  in  this  case  the  maternal  nursing  alone  can  be  medi- 
cally accex^table  ;  for,  at  no  price,  for  no  reason,  should  we 
ever  j)ennit  a  syphilitic  infant  to  be  confided  to  a  healthy 
nurse. 

Third  hypothesis:  Mother  healthy  and  child  syphi- 
litic. 

It  is  here  only  that  the  objection  we  are  considering 
seems  to  assume  a  real  value.  For  here  the  possibility 
of  a  contagion  arises  from  the  simple  statement  even  of 
the  terms  of  the  proposition.  But  we  say,  in  the  first 
place,  that  this  third  situation  rarely  presents  itself  in 
practice.  We  have  shown  that  it  is  almost  exceptional 
to  encounter  a  healthy  mother  vdth  a  sy]3hilitic  child. 
Almost  always,  syphilis  in  the  infant  implies  syphilis  in 
the  mother. 

Still,  however  rare  they  may  be,  cases  of  this  kind 
have  been  cited,  and  I  have  observed,  at  least  I  think 
I  have  observed,  a  certain  number.  They  may,  then, 
be  taken  into  consideration  in  the  present  discussion. 
Now,  the  question  presented  in  such  a  case  is  the  fol- 
lowing :  Will  the  mother  who  nurses  her  child  in  these 
conditions  be  in  danger  of  receiving  syphilis  from  it? 
Theoretically,  one  would  be  induced  to  answer  in  the  af- 
firmative. Wherefore,  in  fact,  should  not  this  mother, 
who  is  healthy,  receive  the  infection  from  her  child  who 
is  syphilitic  ? 

Practically,  on  the  contrary,  one  comes  to  an  opposite 
conclusion.  Practically,  one  never  sees  a  child,  syphilitic 
from  birth  (from  birth,  be  it  well  understood),  infect  *  its 

*  On  the  contrary,  an  infant  born  healthy,  and  afterward  contracting  syphi- 
lis from  another  person  (it  may  be   a  nurse,  for  example),   is  ultra-contagious 


DANGERS  TO  SOCIETY— SOCIAL  PROPHYLAXIS.     191 

motlier  while  nursing  it.  Never  does  one  encounter  a 
case,  however  plausible  in  theory  it  may  be,  of  a  mother 
nursing  her  own  syphilitic  child  and  contracting  syjjhilis 
from  it. 

Let  one  explain  this  as  one  chooses,  it  matters  little 
to  us  at  this  moment.  It  is  always  a  fact,  a  substantial 
fact,  which  obtrudes  itself  in  the  name  of  clinical  ob- 
servation, and  which  involves,  in  our  present  study,  a 
considerable  interest.  Pointed  out  long  ago  by  an  Eng- 
lish author  —  Abraham  CoUes  ^"  —  and  known  to  us  un- 

for  its  mother.  It  is  thus,  as  has  been  many  times  observed,  that  the  contagion  of 
the  mother  is  oecasioned  by  the  infant,  under  the  following  conditions  :  An  infant 
is  born  healthy,  of  healthy  parents ;  it  is  temporarily  confided  to  a  syphilitic  nurse 
and  receives  the  syphilis  from  her ;  returning  to  the  maternal  breast  it  then  in- 
oculates the  mother  with  syphilis.  Cases  of  this  kind  are  found  signalized  every- 
where. I  have  related  a  number  in  my  Legons  sur  les  nourrices  et  les  nourrissons 
syphilitiques,  and  I  think  it  sufficient  here  to  simply  announce  the  fact  without 
supporting  it  by  particular  citations. 

*  It  is  a  curious  fact  that  I  have  never  witnessed  nor  ever  heard  of  an  instance 
in  which  a  child  deriving  the  infection  of  syphilis  from  its  parents  has  caused  an 
ulceration  in  the  breast  of  its  mother." — Abraham  Colles,  "  Practical  Observations 
on  the  Venereal  Disease  and  on  the  Use  of  Mercury,"  London,  1837. 

I  am  aware  that  many  cases  have  been  cited  in  opposition  to  this  law,  or,  if 
the  word  appears  a  little  ambitious,  to  the  proposition  of  Colles.  What  the 
cases  in  question  are  worth  I  can  not  say  ;  for  my  part,  I  have  never  encountered 
similar  ones,  at  least  up  to  the  present  time. 

It;  is  assuredly  a  very  surprising  thing  to  see  a  healthy  woman  nursing  her 
infant,  covered  with  syphilis,  remaining  healthy  in  contact  with  this  infant,  not 
contracting  the  syphilis  from  it.  This  is  indeed  so  extraordinary  that  one  always 
questions  if  one  is  not  deceived,  if  this  woman  is  indeed  really  exempt,  if  she  does 
not  escape  the  contagion  for  the  simple  reason  that  she  has  already  been  con- 
taminated, either  before  or  during  pregnancy.  In  a  word,  one  is  always  tempted 
to  believe  that  this  woman  is  syphilitic,  but,  for  some  reason  or  another,  syphilis 
has  not  been  detected  in  her  at  an  opportune  moment — that  is  to  say,  at  a  mo- 
ment when  unequivocal  manifestations  would  surely  have  been  attested.  Such  is, 
at  least,  the  interpretation  which  physicians,  who  deny  the  paternal  heredity  of 
syphilis,  give  to  the  proposition  of  Colles.  For  them,  there  can  be  no  syphilitic 
infant  without  a  syphilitic  mother ;  for  them,  the  infection  of  the  infant  implies 
the  infection  of  the  mother.  "  Then,"  say  they,  "  there  is  nothing  astonishing 
that  a  syphilitic  infant  does  not  infect  its  mother.  It  can  not  infect  her,  because 
she  is  already  syphilitic.  One  syphilitic  has  nothing  to  fear  from  another  syphi- 
Utic." 

The  question,  in  effect,  would  be  decided  in  this  sense  if  one  always  verified 


192    .  SYPHILIS  AND  MARRIAGE. 

der  tlie  name  of  the  laio  of  Colles,  tMs  singular  immu- 
nity of  the  mother  against  infection  from  her  infant  has 
since  then  impressed  numbers  of  physicians.  It  is,  we 
may  say,  generally  accepted  in  our  day  as  an  undeni- 
able fact,  even  confirmed  by  an  almost  unanimous  assent. 

syphilis  in  the  mothers  of  syphilitic  infants.  But  that  is  precisely  what  one  does 
not  always  establish.  Must  one  believe  that  it  -exists,  even  when  one  has  no  proof 
of  it  ?  It  is  this  conclusion  which  certain  of  our  confreres  arrive  at.  Mr.  Hutch- 
inson has  even  built  a  complete  theory  upon  this  basis,  to  which  it  will  not  be 
without  interest  to  call  the  attention  of  the  reader. 

According  to  our  eminent  colleague,  the  law  of  Colles  can  find  no  other  possible 
explanation  than  in  the  infection  of  the  mother.  And  yet  he  is  the  iirst  to  recog- 
nize that  most  commonly  one  can  not  verify  the  signs  of  infection  in  the  mother. 
If,  then,  says  he,  this  woman  be  syphilitic,  she  must  be  so  in  a  peculiar  manner, 
according  to  a  certain  mode  which  admits  of  her  being  syphilitic  without  apparent 
manifestations. 

Well,  continues  he,  that  is  what  takes  place,  very  probably.  It  is  to  be  believed 
that  the  maternal  syphilis,  derived  in  utero  from  a  syphilitic  foetus,  is  a  syphilis  of 
a  special  order — a  syphilis  miligatcd,  tempered,  modified,  susceptible  of  not  betray- 
ing itself  by  any  external  symptom,  or  indeed  of  remaining  a  long  time  latent — 
even  indefinitely  latent.  Consequently,  this  syphilis  may  escape  us,  may  elude  all 
our  investigations,  when,  nevertheless,  it  exists,  and  infects  the  maternal  organism 
so  profoundly  as  to  render  it  refractory  to  subsequent  contamination. 

As  an  argument  for  the  support  of  this  more  than  bold  hypothesis,  Mr.  Hutch- 
inson recalls  to  mind  that  virulent  diseases  manifest  an  evolution  and  a  gravity 
quite  different,  according  to  their  mode  of  penetration  into  the  economy.  See,  says 
he,  the  variolous  virus.  Inti'oduced  into  the  organism  by  way  of  inoculation,  it 
only  determines  an  affection  comparatively  light,  which  results  in  death  only  once 
in  five  hundred  times.  Absorbed  by  inhalation,  on  the  contrary,  it  produces  a 
very  grave  disease,  which  becomes  fatal  once  in  four  times.  Apply  this  to  syphilis, 
and  you  will  easily  comprehend  that  a  syphilis  derived  from  contamination  of  the 
fcetal  blood  may  differ  absolutely  from  the  syphilis  derived  from  a  tegumentary 
inoculation,  both  in  the  symptoms  of  its  evolution  and  in  gravity.  Developing 
the  exposition  of  his  theory,  Mr.  Hutchinson  admits  the  possibility  of  three  orders 
of  cases  in  syphilis  by  conception,  viz. : 

"  1.  A  first  group,  in  which  the  diathesis  manifests  itself  by  the  habitual  symp- 
toms of  the  secondary  period.  This  is  only  exceptional ;  and  it  is  even  to  be 
believed,  according  to  the  author,  that  the  cases  of  this  kind  are  derived  from  a 
syphilis  by  ordinary  contagion,  rather  than  from  a  syphilis  by  conception. 

"  2.  A  second  group,  in  which  the  infection  is  characterized  by  specific  symp- 
toms, but  of  a  light  order,  of  a  form  essentially  benign  ;  an  unhealthy  condition 
during  pregnancy,  loss  of  hair,  and,  later  on,  '  months  or  years  later,'  ulcerations 
of  the  tongue,  palmar  lesions,  gummata  of  the  cellular  tissue. 

"  3.  A  third  group  (this  comprehending,  at  least,  one  half  of  the  cases),  in  which 
the  disease  docs  not  betray  itself  by  awj  symptom,  by  any  disturbance  of  the  health. 


DANGERS   TO  SOCIETY— SOCIAL  PROPHYLAXIS.     193 

"It  is  certain,"  M.  Ricord  has  written,  "  that,  in  the  case 
where  the  mother  has  escaped  syphilis  while  carrying  a 
syphilitic  infant  in  her  womb,  she  never  afterward  con- 
tracts the  syphilis  by  nursing  her  diseased  infant. "  Like- 
wise, M.  Diday :  "ISTever  does  an  infant,  syphilitic  from 
birth,  communicate  the  disease  to  the  mother  who  nurses 
it."  As  to  myself,  I  have  never,  to  this  day,  observed  a 
single  well-authenticated  fact  in  contravention  of  the  law 
of  CoUes,  and  I  hold  this  law  as  absolutely  consistent  with 
the  results  of  the  clinic. 

Then,  to  return  to  our  subject,  here  again,  even  in  this 
situation,  so  perilous  in  aj^pearance,  of  a  healthy  mother 

This  absence  of  all  symptoms  during  the  first  years  does  not  exclude  the  possi- 
bility of  tertiary  accidents  in  a  future,  more  or  less  distant.  But,  nu)st  often,  no- 
thing is  produced,  and  the  syphilitic  woman  infected  in  this  way  generally  remains 
free  from  all  specific  manifestations  during  her  life." — ("  On  Colles's  Law  and  on 
the  Communication  of  Syphilis  from  the  Fcetus  to  its  Mother,"  "  Medical  Times 
and  Gazette,"  December,  1876,  p.  643.) 

I  will  not  stop  here  to  discuss  this  theory,  for,  to  speak  truly,  it  defies  at 
present  all  criticism.  If  would  be  necessary,  in  fact,  either  for  its  verification  or 
its  refutation,  to  bring  a  whole  series  of  clinical  facts  minutely  observed  in  a 
special  direction,  and  we  are  not  prepared  with  a  criterion  of  this  kind.  This  is  a 
new  field  of  investigation  which  is  opened  to  us,  but  in  which  the  first  landmarks 
are  hardly  yet  placed. 

I  shall  consider  it  my  duty,  however,  to  mention  an  interesting  observation 
which  has  just  been  communicated  to  me  by  Dr.  Charrier,  and  which  confirms,  in 
one  point,  the  doctrine  of  Mr.  Hutchinson.  The  reader  will  find  this  observation 
reproduced  among  the  "  Notes  and  Illustrative  Cases  "  appended  to  this  work 
(Note  VI). 

Definitely,  in  the  present  state  of  science,  two  important  facts  result  from 
clinical  observation,  viz. : 

1.  That  a  healthy  woman  becoming  enceinte  from  contact  with  a  syphilitic  man 
may  give  birth  to  a  syphilitic  infant,  while  she  remains  healthy  (in  appearance,  at 
least). 

2.  That  this  woman,  nursing  a  syphilitic  infant,  is  not  liable  to  receive  the  con- 
tagion from  it. 

It  only  remains  to  interpret  this  singular  immunity,  and,  notably,  to  determine 
if  it  be  explicable,  as  certain  authorities  pretend,  by  a  sort  of  special  and  latent  in- 
fection of  the  mother — an  infection  derived  from  the  fcetus  by  a  not  less  special 
mode  of  contamination.  This  the  future  alone  can  teach  us,  and  we  are  compelled 
at  present  to  reserve  judgment. 


194  SYPHILIS  AND  MARRIAGE. 

exposed  to  tlie  contact  of  a  sypliilitic  infant,  maternal 
nursing  does  not  involve  any  danger. 

There  remains,  finally,  a  fourth  and  last  alternative : 
mother  syphilitic  and  child  healthy. 

This  is  the  preceding  situation  reversed.  Well,  as  in 
the  preceding  case,  contagion  is  not  exerted  here.  A  child 
born  healthy,  although  the  offspring  of  syphilitic  parents, 
has  never  taken  the  syphilis  in  nursing  from  its  mother. 
As  to  myself,  I  declare  that  I  have  never  seen  anything  of 
this  character.  I  declare  that  I  am  not  aware  of  a  single 
example  of  a  mother  having  given  birth  to  a  healthy  in- 
fant, then  afterward  infecting  it  in  the  capacity  of  nurse.* 

Recapitulating,  then,  gentlemen,  whichever  it  may  be 
of  the  four  alternatives  that  we  are  considering,  always 
and  invariably  we  find  that  the  nursing  of  the  infant  by  its 
mother  is  free  from  the  theoretical  dangers  which  might 
be  supiDOsed. 

From  this  an  easy  conclusion  is  to  be  deduced :  it  is 
that  on  no  account  should  one  oppose  in  either  case  the 
mother  nursing  her  infant. 

Now,  as  from  the  other  point  of  view  there  is  a  valid 
reason,  superior  to  every  other,  against  the  infant  being 
confided  to  a  nurse,  the  question  is  resolved  essentially 
the  same  in  two  different  ways.  And  we  come  to  this  as 
a  final  conclusion : 

That  under  such  conditions  the  maternal  nursing  is 
the  only  rational  and  %>ractical  means  for  tJie  raising  of 
the  infant. 

*  It  is  to  be  well  understood — and  I  only  insist,  to  avoid  a  shade  even  of  am- 
biguity— that  I  speak  here  of  a  mother  having  contracted  syphilis  either  before  or 
during  pregnancy.  For  a  mother  contracting  syphilis  after  her  accouchement  is 
ultra-contagious  for  her  infant.  That  is  a  fact  of  common  observation.  It  will  be 
sufficient  to  recall,  in  this  connection,  those  cases  so  numerous  in  which  one  has 
seen  the  unfortunate  nurse,  after  having  contracted  syphilis  from  a  syphilitic  nurs- 
ling, afterward  communicate  it  to  her  own  infant. 


DANGERS  TO  SOCIETY— SOCIAL  PROPHYLAXIS.     195 

Given  tlie  case  of  an  infant  syphilitic  or  only  suspected 
of  syphilis,  it  is  the  mother  of  this  infant  who  alone  may 
and  ought  to  serve  as  its  nurse. 

This  is  not  doubtful ;  for  a  number  of  reasons  which 
I  can  not  here  unfold,  it  does  not  admit  of  discussion. 
Such  is  the  law.  And,  besides,  I  will  add,  in  conclusion, 
that  even  if,  in  such  circumstances,  the  maternal  nurs- 
ing should  be  attended  with  some  danger,  either  for  the 
mother  or  for  the  child,  this  consideration  would  in  no 
wise  modify  the  duty  which  is  imposed  upon  the  physician 
toward  society.  This  duty,  in  any  state  of  the  case,  would 
none  the  less  continue  to  exist. 

In  this  hypothesis,  that  is  to  say,  if  the  maternal  nurs- 
ing should  offer  some  danger,  it  would  be  your  duty  as 
physicians  to  contend  with  this  new  difficulty,  to  devise 
some  expedient  by  which  the  possibility  of  contagion  from 
the  mother  to  the  infant,  or  from  the  infant  to  the  mother, 
might  be  averted.  But  we  should  not  on  that  account  be 
relieved  from  the  strict  and  imperative  obligation  which  a 
respect  for  the  health  of  others  imjposes  upon  us.  At  no 
price,  on  no  account,  should  we  consent  that  an  infant 
syphilitic,  or  even  only  suspected  of  syphilis,  be  confided 
to  a  healthy  nurse. 

The  protection  of  society  constitutes,  then,  in  this  re- 
spect— I  repeat  it  again,  and  I  can  not  too  often  repeat  it 
— the  capital,  predominant  indication,  superior  to  every 
other  consideration — and  this,  because  this  indication  re- 
sponds to  interests  of  a  general  order,  because  it  tends  to 
a  result  which  ought  to  be  the  aim  of  our  common  and 
constant  efforts,  viz.,  to  prevent  tlie  diffusion  of  the  pox 
by  confining  it  to  its  sources  of  origin,  by  preventing  it 
from  being  spread  abroad  and  disseminating  its  germs  of 
contagion. 


NOTES  AND  ILLUSTRATIVE  CASES. 


NOTE  I. 

".  .  .  .  Foe  my  part  alone,  I  have  in  hand  (to  speak 
only  of  recorded  cases)  eighty-seven  observations  relative 
to  syphilitic  subjects,  undoubtedly  syphilitic,  who,  hav- 
ing married,  have  never  communicated  to  their  wives  the 
least  suspicious  phenomenon,  and,  what  is  more,  have 
begotten — these  eighty-seven — a  total  of  one  hundred  and 
fifty-six  children,  absolutely  healthy  "  (page  19). 

From  its  great  importance,  this  proposition  dominates 
the  whole  subject  developed  in  this  book.  On  this  ac- 
count I  have  judged  it  indispensable  to  legitimize  it  by  an 
expose  of  the  facts  from  which  it  is  deduced.  I  can  not 
here  relate  in  extenso  these  eighty-seven  observations, 
some  of  which  are  quite  long.  But  I  will  at  least  furnish 
an  abstract  of  them,  assuredly  quite  concise,  but  suffi- 
cient, I  think,  to  fix  the  conviction  of  the  reader  : 

Case  I. — Indurated  chancre  of  the  glans  ;  roseola  ;  buccal 
syphilides  ;  epididymitic  sarcocele  ;  treatment  active  and  pro- 
longed ;  marriage  six  years  after  the  debut  of  the  syphilis  ;  wife 
remaining  uncontaminated  ;  three  healthy  children,  the  eldest  of 
whom  is  now  six  years  old  ;  gumma  of  the  penis  after  the  birth 
of  the  second  child  ;  resumption  of  treatment. 

Case   II. — Indurated   chancre  ;    roseola ;    palmar   syphilides  ; 


NOTES  AND  ILLUSTRATIVE  CASES  I97 

buccal  syptilides  ;  treatment  quite  long  but  irregular ;  mamage 
six  years  after  the  d^but  of  the  infection  ;  second  marriage  some 
years  later  ;  both  wives  remaining  uncontaminated  ;  five  children 
from  these  two  marriages,  all  absolutely  healthy  ;  recurrence  of 
palmar  psoriasis  after  the  birth  of  the  first  and  third  child. 

Case  III.  —  Indurated  chancre  ;  roseola  ;  buccal  syphilides  ; 
recurrence  of  the  roseola  in  circinate  form  ;  treatment  prolonged  ; 
marriage  three  years  after  the  debut  of  the  syphilis  ;  wife  remain- 
ing uninfected  ;  two  healthy  children,  the  eldest  of  whom  is  now 
nine  years  of  age  ;  ulcerated  tubercle  of  the  penis  nine  years  after 
marriage. 

Case  IV.  —  Indurated  chancre  ;  roseola  ;  buccal  syphilides  ; 
eruption  of  crusts  on  the  hairy  scalp  ;  palmar  and  plantar  syphi- 
lides ;  recurrence  of  roseola;  treatment  quite  prolonged  ;  marriage 
four  years  after  debut  of  the  syphilis  ;  wife  remaining  uninfected  ; 
a  healthy  child,  now  seventeen  years  old  ;  later,  dry,  tubercular 
syphilide  (form  benign). 

Case  V. — Indurated  chancre  of  prepuce  ;  roseola  ;  buccal  and 
genital  syphilides ;  iritis ;  average  treatment ;  marriage  three 
years  after  debut  of  syphilis ;  wife  remaining  healthy  ;  four 
healthy,  well-developed  children. 

Case  VI. — Indurated    chancre  ;    roseola  ;    buccal    syphilides 
with  multiple   recurrences ;    treatment  irregular ;    marriage   six 
years  after  debut  of  the  infection;    wife  remaining  uninfected ;  • 
five  healthy  children. 

Case  VII, — Indurated  chancre  of  the  glando-preputial  furrow; 
immediate  'treatment,  active  and  prolonged  ;  no  other  accident 
than  roseola  ;  marriage  after  nineteen  months  of  infection  ;  wife 
remaining  healthy  ;  a  healthy  child  now  aged  six  years. 

Case  VIII. — Indurated  chancre  ;  papular  syphilide  ;  recur- 
rence five  years  later  of  an  erythemato-papular  syphilide;  consid- 
erable treatment  (pills  of  proto-iodide  during  four  years,  etc.); 
marriage   eight  years   after  d^but  of  syphilis  ;    wife  remaining 

healthy  ;  three  healthy  children. 
14 


198  SYPHILIS  AND  MAREIAOE. 

Case  IX. — Indurated  chancre  of  penis  ;  papular  syphilide. 
Crusts  of  hairy  scalp  ;  buccal  syphilides  with  quite  numerous 
relapses  ;  prolonged  methodic  treatment ;  marriage  in  the  third 
year  ;  wife  remaining  uninfected  ;  two  healthy  children. 

Case  X. — Primary  accident  unperceived  ;  cutaneous  and 
mucous  syphilides  ;  treatment  from  six  to  eight  months  ;  mar- 
riage after  eight  years  of  infection  ;  wife  remaining  uninfect- 
ed ;  five  healthy  children,  the  eldest  of  whom  is  now  twelve 
years  old  ;  tubercular  syphilide  of  the  thorax  after  birth  of 
third  child  ;  gumma  of  the  palatine  arch  after  the  birth  of  fifth 
chUd. 

Case  XI. — Indurated  chancre  ;  papular  syphilide  ;  crusts  of 
hairy  scalp  ;  tonsillar  syphilides  ;  treatment  prolonged ;  marriage 
five  years  after  debut  of  infection  ;  wife  remaining  healthy  ;  two 
healthy  children. 

Case  XII. — Indurated  chancre  ;  mucous  syphilides  ;  cephalal- 
gia ;  methodic  treatment ;  marriage  eleven  years  after  the  debut 
of  the  infection  ;  wife  remaining  healthy  ;  a  healthy  child,  at  pres- 
ent nine  years  of  age. 

Case  XIII. — Chancre  of  the  nose  ;  mucous  syphilides  ;  cervi- 
cal adenopathies  ;  treatment  for  some  months  ;  marriage  the  third 
year  ;  wife  remaining  healthy  ;  three  healthy  children. 

Case  XIV. — Indurated  chancre  of  the  penis  ;  roseola  ;  buccal 
■  and  anal  syphilides  ;  prolonged  treatment  by  iodide  of  potassium, 
without  mercury  ;  mai-riage  six  years  after  the  debut  of  the  dis- 
ease ;  wife  remaining  healthy  ;  a  healthy  child  ;  debut  of  cerebral 
syphilis  (apoplectiform  stroke,  hemiplegia,  etc.)  five  months  after 
marriage,  four  months  before  the  birth  of  the  child. 

Case  XV. — Indurated  chancre  ;  roseola  ;  buccal  syphilides  ; 
short  treatment ;  marriage  nine  years  after  infection  ;  wife  re- 
maining healthy  ;  a  healthy  child. 

Case  XVI. — Indurated  chancre  ;  papular  syphilide  ;  buccal 
syphilides  with  multiple  recurrences  ;  five  years  later,  nasal  caries; 
frightful  ozsena  ;  treatment  extremely^  energetic  during  a  number 


NOTES  AND  ILLUSTRATIVE  GASES  199 

of  years  ;  marriage  nine  years  after  the  d6but  of  the  infection  ; 
wife  remaining  healthy  ;  a  healthy  child. 

Case  XYII. — Indurated  chancre  ;  roseola  ;  mucous  syphilides; 
eighteen  months'  treatment;  marriage  eleven  years  after  the  debut 
of  the  syphilis  ;  wife  remaining  healthy  ;  two  healthy  children ; 
papulo-tubercular  syphilide  and  costal  periostosis  after  the  birth 
of  the  two  children. 

Case  XVIII. — Indurated  chancre  of  the  thumb  ;  papular 
syphilide  ;  tonsillar  syphilides  ;  cephalalgia  ;  treatment  energetic 
and  prolonged  ;  marriage  four  years  after  debut  of  syphilis  ;  wife 
remaining  healthy  ;  three  healthy  children. 

Case  XIX. — Indurated  chancre  ;  erythemato-papular  syphi- 
lide ;  buccal  syphilides  ;  multiple  nervous  accidents  ;  anaemia ; 
asthenia  ;  treatment  active  and  prolonged  ;  marriage  six  years 
after  debut  of  syphilis  ;  wife  remaining  healthy  ;  four  healthy 
children ;  after  the  birth  of  these  children,  cerebro-spinal  acci- 
dents, very  probably  of  specific  origin. 

Case  XX. — Indurated  chancre  ;  roseola  ;  buccal  syphilides  ; 
treatment  for  six  months  ;  marriage  fifteen  years  after  debut  of 
syphilis  ;  wife  remaining  healthy  ;  a  healthy  child  ;  one  month 
after  the  birth  of  the  child  accidents  of  cerebral  syphilis  ;  death. 

Case  XXI. — Indurated  chancre  ;  papular  syphilide  ;  patches 
on  the  tonsils  ;  treatment  of  about  one  year  ;  marriage  seven  years 
after  debut  of  syphilis  ;  wife  remaining  healthy  ;  two  healthy 
children  (the  eldest  now  about  fifteen  years  old)  ;  debut  of  cere- 
bral syphilis  three  years  after  the  birth  of  second  child  ;  death. 

Case  XXII. — Indurated  chancre  ;  various  secondary  acci- 
dents ;  treatment  of  one  year ;  marriage  eight  years  after  debut 
of  syphilis  ;  wife  remaining  healthy  ;  a  healthy  child. 

Case  XXIII. — Indurated  chancre  ;  papulo-crusted  syphilide  ; 
ecthymatous  syphilide  (ecthyma  deep)  ;  rupia  ;  violent  cephalal- 
gia ;  hemiplegia  ;  recurrence  of  rupial  syphilides  ;  treatment  very 
energetic,  very  prolonged  ;  marriage  two  years  after  debut  of 
syphilis  ;  wife  remaining  uninfected  ;  healthy  child  ;  later,  diplo- 


200    -  SYPHILIS  AND  MARRIAGE. 

pia  ;  ephemeral  attacks  of  right  hemiplegia  ;  nasal  syphilides  ; 
ecthyma  of  the  legs. 

Case  XXIV. — Indurated  chancre ;  buccal  syphilides  ;  treat- 
ment for  some  months  ;  marriage  eleven  years  after  debut  of 
syphilis  ;  wife  remaining  uninfected  ;  two  healthy  children.  Af- 
ter the  birth  of  these  two  children  tibial  periostosis  and  specific 
glossitis. 

Case  XXY. — Indurated  chancre  ;  roseola  ;  buccal  syphilides  ; 
active,  prolonged  treatment ;  marriage  fourteen  months  after 
debut  of  syphilis  ;  wife  remaining  uninfected  ;  two  healthy  chil- 
dren. 

Case  XX VL — Indurated  chancre  ;  buccal  syphilides,  multiple 
and  relapsing  onyxis  ;  papulo-squamous  circinate  syphilide  ;  peri- 
ostosis ;  tubercle  of  the  glans  ;  treatment  active  and  prolonged ; 
marriage  nine  years  after  debut  of  syphilis  ;  wife  remaining  unin- 
fected ;  healthy  child. 

Case  XXVII. — Indurated  chancre ;  papulo-squamous  syphi- 
lide ;  secondary  costal  periostosis  ;  ecthyma  ;  tibial  exostosis  ; 
treatment  prolonged  ;  marriage  six  years  after  debut  of  syphilis  ; 
wife  remaining  healthy  ;  one  healthy  child. 

Case  XXVIII. — Indurated  chancre  ;  slight  secondary  acci- 
dents ;  prolonged  treatment ;  marriage  four  years  after  debut  of 
syphilis  ;  wife  remaining  healthy  ;  two  healthy  children. 

Case  XXIX. — Indurated  chancre  ;  roseola;  buccal  syphilides  ; 
prolonged  treatment  ;  marriage  three  years  after  debut  of  syphilis; 
wife  remaining  healthy  ;  healthy  child  ;  multiple  accidents  after 
birth  of  child  ;  specific  sarcocele,  periostosis,  nasal  ulcerations, 
tubercular  syphilide  of  the  nose  ;  diabetes. 

Case  XXX. — Indurated  chancre  of  glando-preputial  furrow  ; 
papular  syphilide  ;  circumscribed  ecthyma  ;  specific  hydrarthrosis  ; 
active  treatment ;  marriage  three  years  after  debut  of  disease  ; 
wife  remaining  uninfected  ;  three  healthy  children. 

Case  XXXI. — Indurated  chancre  ;  roseola  ;  cnisted  eruption 
of  hairy  scalp  ;  buccal  syphilides  with  multiple  relapses  ;  alopecia  ; 


NOTES  AND  ILLUSTRATIVE  GASES.  201 

treatment  methodic  and  prolonged  ;  marriage  three  years  after 
debut  of  syphilis  ;  wife  remaining  uninfected  ;  a  healthy  child. 

Case  XXXII. — Indurated  chancre  ;  palmar  psoriasis  ;  treat- 
ment for  several  months  ;  marriage  six  years  after  debut  of  syphi- 
lis ;  wife  remaining  healthy  ;  a  healthy  child  ;  ulcerating  laryn- 
gitis, manifestly  specific,  three  years  after  birth  of  child. 

Case  XXXIII. — Indurated  chancre;  some  secondary  accidents 
of  benign  form ;  later  nasal  osteitis,  perforation  of  the  septum  ; 
treatment  not  prolonged  ;  marriage  after  five  years  of  the  dis- 
ease ;  wife  remaining  uncontaminated  ;  four  healthy  children  ; 
fatal  cerebral  syphilis  ;  the  last  child  was  procreated  after  the 
debut  of  the  cerebral  accidents  (epileptiform  attacks,  psychical 
troubles). 

Case  XXXIV. — Primitive  accident  not  recognized  ;  roseola  ; 
eruption  of  crusts  of  hairy  scalp  ;  eight  to  ten  months'  treatment ; 
marriage  twelve  years  after  debut  of  the  disease  ;  wife  remaining 
uninfected  ;  four  healthy  children  ;  fronto-parietal  exostosis  oc- 
curring a  short  time  after  the  birth  of  the  fourth  child. 

Case  XXXV. — Indurated  chancre  ;  secondary  angina  ;  cervi- 
cal adenopathies  ;  mercurial  treatment  of  some  months  ;  marriage 
eleven  years  after  debut  of  syphilis  ;  wife  remaining  uninfected  ; 
a  healthy  child ;  syphilitic  accidents  of  the  cord  preceding  by 
one  year  the  birth  of  the  child. 

Case  XXXVI. — Indurated  chancre  of  the  penis  ;  roseola  ;  ton- 
sillar, lingual,  palatine  syphilides  ;  active  treatment ;  marriage 
one  year  after  debut  of  syphilis  ;  prolonged  treatment  after  mar- 
riage ;  wife  remaining  uninfected  ;  two  healthy  children. 

Case  XXXVII. — Indurated  chancre ;  no  secondary  accidents 
remarked,  except  perhaps  an  anal  papule  ;  mercurial  treatment 
from  three  to  four  months  ;  marriage  nine  years  after  debut 
of  syphilis ;  wife  remaining  uninfected ;  a  healthy  child ;  some 
months  before  the  birth  of  the  child,  debut  of  cerebral  syphilis. 

Case  XXXVIII. — Indurated  chancre  ;  roseola  ;  cervical  ade- 
nopathies ;  mercurial  treatment  of  six  months  ;  marriage  five  years 


202  SYPHILIS  AN'D  MARRIAGE. 

after  debut  of  syphilis  ;  wife  remaining  uninfected  ;  three  healthy- 
children  ;  exostoses  one  year  after  the  birth  of  the  third  child. 

Case  XXXIX. — Indurated  chancre ;  papular  syphilide  ;  mu- 
cous patches  of  the  tongue  ;  prolonged  treatment  ;  marriage  eight 
years  after  debut  of  syphilis  ;  wife  remaining  healthy  ;  healthy 
child. 

Case  XL. — Indurated  chancre  ;  buccal  mucous  patches  ;  treat- 
ment quite  protracted,  principally  of  iodide  of  potassium ;  mar- 
riage five  years  after  debut  of  syphilis ;  wife  remaining  unin- 
fected ;  three  healthy  childi'en  (the  eldest  now  aged  seven 
years). 

Case  XLI. — Indurated  chancre  ;  roseola  ;  buccal  syphilides ; 
prolonged  treatment ;  marriage  five  years  after  debut  of  syphilis  ; 
wife  remaining  uninfected  ;  two  healthy  children. 

Case  XLII. — Indurated  chancre  ;  cutaneous  eruptions  ;  buccal 
syphilides  ;  ecthyma ;  treatment  quite  prolonged  ;  marriage  four 
years  after  debut  of  syphilis  ;  wife  remaining  uninfected  ;  healthy 
child. 

Case  XLIII. — Indurated  chancre  of  index-finger;  erythemato- 
papular  syphilide  ;  alopecia  ;  tonsillar,  labial,  and  lingual  patches  ; 
multiple  adenopathies  ;  cephalalgia  ;  neuralgia  ;  prolonged  treat- 
ment ;  marriage  four  years  after  debut  of  syphilis  ;  wife  remain- 
ing uninfected  ;  two  healthy  children. 

Case  XLIV. — Indurated  chancre  ;  no  other  secondary  acci- 
dents except  buccal  mucous  patches  ;  treatment  prolonged  ;  mar- 
riage four  years  after  debut  of  syphilis  ;  wife  remaining  unin- 
fected ;  two  healthy  children  ;  after  the  birth  of  the  last  child, 
cranial  exostosis,  with  incessant  relapses. 

Case  XLV, — Parchment  chancre  of  the  prepuce  ;  papular 
syphilide  ;  specific  icterus  ;  buccal  syphilides  ;  prolonged  treat- 
ment ;  marriage  eight  years  after  debut  of  syphilis  ;  wife  remain- 
ing uninfected  ;  two  healthy  children. 

Case  XLYI. — Indurated  chancre  ;  buccal  syphilides  ;  specific 
sarcocele  ;  treatment  prolonged  ;  marriage  nine  years  after  d^but 


NOTES  AND  ILLUSTRATIVE  GASES.  203 

of  syphilis  ;  wife  remaining  uninfected  ;  two  healthy  children  (the 
eldest  now  aged  nine  years). 

Case  XL VII. — Two  indurated  chancres  of  the  sulcus  ;  ery- 
themato-papular  syphilide  ;  buccal  syphilides  ;  ecthymatous  syph- 
ilide  of  the  legs  ;  ulcerating  syphilide  of  the  palate  ;  marriage 
in  the  course  of  the  third  year  after  debut  of  the  infection  ; 
treatment  very  energetic  and  protracted  ;  wife  remaining  unin- 
fected ;  healthy  child  ;  dry  tubercle  of  the  penis  some  months 
after  birth  of  child. 

Case  XL VIII. — Indurated  chancre  ;  buccal  syphilides  ;  alope- 
cia ;  circinate  syphilides  of  the  tongue  ;  treatment  active  and 
prolonged  ;  marriage  four  years  after  debut  of  syphilis  ;  wife 
remaining  uninfected  ;  healthy  child  ;  some  months  after  birth  of 
child,  palmar  and  plantar  syphilides  of  papulo-squamous  form. 

Case  XLIX. — Indurated  chancre  ;  roseola  ;  palmar  psoriasis  ; 
buccal  syphilides  ;  iodide  treatment ;  no  mercury  ;  marriage  four 
years  after  debut  of  the  malady  ;  wife  remaining  uninfected  ;  two 
healthy  children  ;  after  birth  of  second  child  patient  infects  his 
wife  from  a  buccal  syphilide  ;  a  pi'egnancy,  happening  the  follow- 
ing year,  terminates  in  an  abortion. 

Case  L. — Two  indurated  chancres  ;  eruptions  of  crusts  of 
hairy  scalp  ;  secondary  angina  ;  choroiditis  ;  buccal  syphilides  ; 
treatment  protracted  ;  marriage  four  years  after  debut  of  syphilis  ; 
wife  remaining  uninfected  ;  healthy  child. 

Case  LI. — Seven  indurated  chancres  ;  roseola ;  impetiginous 
syphilide  of  hairy  scalp  ;  treatment  quite  long  ;  marriage  after 
seven  years  of  the  malady  ;  wife  remaining  uninfected  ;  two 
healthy  children  ;  after  the  birth  of  second  child,  ecthymatous 
syphilide  and  gumma  of  palatine  arch. 

Case  LII. — Parchment  chancre  of  prepuce  ;  roseola  ;  buccal 
syphilides  ;  cephalalgia  ;  digital  psoriasis  ;  prolonged  treatment ; 
marriage  in  the  third  year  of  the  disease ;  wife  remaining  unin- 
fected ;  healthy  child. 

Case  LIII. — Indurated  chancre  ;  papular  syphilide  ;  gummous 


204      -  SYPHILIS  AND  MARRIAGE. 

sypbilide  of  pharynx ;  diplopia ;  treatment  from  eight  to  ten 
months  ;  marriage  ten  years  after  debut  of  infection ;  wife  re- 
maining uninfected  ;  healthy  child  ;  one  year  after  birth  of  child, 
d6but  of  cerebral  syphilis. 

Case  LIV. — Indurated  chancre  ;  circinate  syphilide  of  hairy 
scalp,  papulo-crusted ;  prolonged  treatment ;  marriage  in  the 
fourth  year  of  the  malady ;  wife  remaining  uninfected ;  two 
healthy  children. 

Case  LV. — Indurated  chancre  ;  buccal  syphilides  ;  alopecia  ; 
papular  syphilide  ;  treatment  of  several  months  ;  marriage  four 
years  after  debut  of  disease  ;  wife  remaining  healthy  ;  healthy 
child  ;  one  year  after  birth  of  child,  debut  of  cerebral  syphilis. 

Case  LVI. — Indurated  chancres  ;  roseola  ;  acneiform  syphi- 
lide ;  buccal  syphilides  with  frequent  recurrences  ;  tibial  exosto- 
sis ;  prolonged  treatment ;  marriage  four  years  after  debut  of 
syphilis  ;  wife  remaining  uninfected  ;  two  healthy  children. 

Case  LVII. — Indurated  chancre  ;  buccal  syphilides  ;  super- 
ficial sclerotic  glossitis  ;  prolonged  treatment ;  marriage  in  the 
third  year  of  the  disease  ;  wife  remaining  uninfected  ;  healthy 
child. 

Case  LVIII. — Indurated  chancre  ;  no  secondary  accidents  re- 
marked ;  iodide  treatment ;  gummous  syiDhilides  of  the  palatine 
arch  and  pharynx  ;  frightful  phagedena  of  the  arch,  the  pillars, 
the  tonsils,  the  pharynx  ;  energetic  treatment,  prolonged  several 
years  ;  marriage  five  years  after  debut  of  syphilis  ;  wife  remain- 
ing uninfected  ;  healthy  child. 

Case  LIX. — Indurated  chancre  ;  roseola  ;  buccal  syphilides  ; 
cephalalgia  ;  papular  circinate  syphilide  ;  treatment  prolonged  ; 
marriage  six  years  after  debut  of  syphilis  ;  wife  remaining  unin- 
fected ;  healthy  child. 

Case  LX, — Indurated  chancre ;  buccal  syphilides  ;  crusts  of 
hairy  scalp  ;  treatment  prolonged  ;  marriage  eight  years  after  de- 
but of  syphilis  ;  wife  remaining  uninfected  ;  healthy  child. 

Case  LXI. — Indurated  chancre  ;   buccal  syphilides  ;  ecthyma 


NOTES  AND  ILLUSTRATIVE  GASES  205 

of  the  foot ;  treatment  of  some  months  only  ;  marriage  three 
years  afer  debut  of  syphilis  ;  wife  remaining  uninfected  ;  healthy 
child. 

Case  LXII. — Indurated  chancre  ;  roseola  ;  cephalalgia  ;  buc- 
cal syphilides  ;  psoriasiform  syphilide  ;  treatment  prolonged  ;  mar- 
riage four  years  after  debut  of  syphilis  ;  wife  remaining  uninfect- 
ed ;  healthy  child. 

Case  LXIII. — Indurated  chancre  ;  roseola  ;  buccal  syphilides  ; 
cephalalgia  ;  treatment  prolonged  ;  marriage  four  years  after  de- 
but of  syphilis  ;  wife  remaining  uninfected  ;  healthy  child. 

Case  LXIV. — Indurated  chancre  ;  roseola  ;  buccal  syphilides  ; 
treatment  very  protracted ;  marriage  five  years  after  debut  of 
syphilis  ;  wife  remaining  uninfected  ;  healthy  child. 

Case  LXV. — Indurated  chancre  ;  roseola  ;  buccal  syphilides  ; 
treatment  of  about  one  year  ;  marriage  in  fourth  year  of  the 
disease  ;  wife  remaining  uninfected  ;  healthy  child  ;  specific  sar- 
cocele  at  the  moment  of  birth  of  child. 

Case  LXVI. — Indurated  chancre ;  cutaneous  and  mucous 
syphilides  ;  several  months'  treatment ;  marriage  eight  years  after 
debut  of  syphilis ;  wife  remaining  uninfected ;  three  healthy 
children  ;  twelve  years  after  marriage,  paralysis  of  the  sixth  pair 
of  nerves. 

Case  LXVII. — Indurated  chancre  ;  no  other  secondary  acci- 
dents remarked  besides  buccal  syphilides  ;  treatment  of  one  year  ; 
marriage  in  the  second  year  of  the  disease  ;  wife  remaining  unin- 
fected ;  three  healthy  children  ;  afterward,  sclerous  glossitis. 

Case  LXVIII. — Indurated  chancre  ;  roseola  ;  ecthymatous 
syphilide  of  the  legs  ;  treatment  quite  prolonged  ;  marriage  four 
years  after  debut  of  syphilis ;  wife  remaining  uninfected  ;  two 
healthy  children. 

Case  LXIX, — Indurated  chancre  ;  roseola  ;  buccal  syphilides; 
prolonged  treatment ;  marriage  ten  years  after  debut  of  syphilis  ; 
wife  remaining  uninfected  ;  healthy  child. 

Case  LXX. — Indurated  chancre  ;  papular  syphilide  j  buccal 


206     .  SYPHILIS  AND  MARRIAGE. 

and  anal  syphilides ;  iritis  ;  treatment  prolonged  ;  marriage  five 
years  after  debut  of  syphilis  ;  wife  remaining  uninfected ;  two 
healthy  children. 

Case  LXXI. — Indurated  chancre  ;  buccal  syphilides  ;  erup- 
tion on  hairy  scalp  ;  treatment  quite  prolonged  ;  man-iage  eight 
years  after  debut  of  syphilis ;  wife  remaining  uninfected  ;  a  healthy 
child. 

Case  LXXII. — Indurated  chancre  ;  buccal  syphilides  ;  palmar 
psoriasis  ;  four  months'  treatment ;  marriage  five  years  after  de- 
but of  syphilis  ;  wife  remaining  uninfected  ;  healthy  child  ;  after- 
ward, gumma  of  the  palatine  arch. 

Case  LXXIII. — Indurated  chancre  ;  diverse  secondary  acci- 
dents ;  treatment  of  some  months  ;  six  years  later,  palmar  psori- 
asis ;  resumption  of  treatment ;  marriage  thirteen  years  after 
debut  of  syphilis  ;  wife  remaining  uninfected  ;  two  healthy  chil- 
dren. 

Case  LXXIV. — Indurated  chancre  ;  buccal  syphilides  ;  pal- 
mar psoriasis  ;  energetic  treatment ;  marriage  in  the  course  of  the 
second  year  of  the  disease  ;  wife  remaining  uninfected  ;  healthy 
child. 

Case  LXXY. — Indurated  chancre  ;  cutaneous  and  mucous 
syphilides  ;  treatment  irregular,  still  suflBciently  prolonged  ;  mar- 
riage four  years  after  debut  of  syphilis  ;  wife  remaining  unin- 
fected ;  a  healthy  child  ;  two  years  later,  papulo-crusted  syphilide 
of  circinate  form. 

Case  LXXVI. — Indurated  chancre  ;  cutaneous  syphilides  ; 
treatment  of  some  months  ;  marriage  five  years  after  debut  of 
syphilis  ;  wife  remaining  uninfected  ;  two  healthy  children  ;  four 
years  after  birth  of  second  child,  debut  of  cerebral  syphilis. 

Case  LXXVII. — Indurated  chancre  ;  roseola  ;  buccal  syphi- 
lides ;  ecthyma  of  the  leg  ;  treatment  prolonged  ;  marriage  two 
years  after  debut  of  syphilis  ;  wife  remaining  uninfected  ;  a 
healthy  child. 

Case  LXXYIII. — Indurated  chancre  ;   no  secondary  accidents 


NOTES  AND  ILLUSTRATIVE  GASES.  207 

remarked ;  mercurial  treatment  for  six  months  ;  marriage  three 
years  after  debut  of  syphilis  ;  wife  remaining  uninfected  ;  three 
healthy  children  ;  after  the  birth  of  the  third  child,  debut  of  lo- 
comotor ataxia. 

Case  LXXIX. — Labial  chancre  ;  cutaneous  syphilides  ;  no 
treatment ;  marriage  seven  years  after  debut  of  syphilis ;  wife 
remaining  healthy  ;  healthy  twin  children  ;  after  the  birth  of 
these  two  children,  palatine  gumma,  tertiary  ulcerations  of  the 
nasal  fossse,  cephalalgia. 

Case  LXXX. — Indurated  chancre  ;  cutaneous  and  mucous 
syphilides ;  palmar  psoriasis ;  prolonged  treatment ;  marriage 
four  years  after  debut  of  syphilis  ;  wife  remaining  uninfected  ;  a 
healthy  child. 

Case  LXXXI. — Indurated  chancre  ;  papular  syphilide  ;  buc- 
cal and  genital  syphilides  ;  treatment  prolonged ;  marriage  six 
years  after  debut  of  syphilis  ;  wife  remaining  uninfected  ;  two 
healthy  children. 

Case  LXXXII. — Indurated  chancre  of  glans  ;  marriage  al- 
most immediately  after  cicatrization  of  chancre  ;  various  second- 
ary accidents,  buccal  syphilides,  palmar  psoriasis ;  treatment 
prolonged ;  the  patient  avoiding  any  fecundating  connection 
during  five  years ;  the  following  year  a  healthy  child  ;  wife 
remaining  uninfected ;  consecutive  to  the  birth  of  the  child, 
tibial  periostosis  ;  cerebral  syphilis. 

Case  LXXXIII. — Primary  accident  not  recognized  ;  roseola 
in  1866  ;  buccal  syphilides  ;  prolonged  treatment ;  marriage  six 
years  after  d^but  of  syphilis  ;  wife  remaining  uninfected  ;  healthy 
child. 

Case  LXXXIV. — Indurated  chancre  ;  buccal  syphilides  ;  pro- 
longed treatment ;  marriage  fourteen  years  after  debut  of  dis- 
ease ;  wife  remaining  uninfected  ;  a  healthy  child. 

Case  LXXXV. — Indurated  chancre  ;  roseola  ;  palmar  psori- 
asis ;  treatment  prolonged  ;  marriage  seven  years  after  debut  of 
syphilis  ;  wife  remaining  uninfected  ;  a  healthy  child. 


208  SYPHILIS  AND  MARRIAGE. 

Case  LXXXVI. — Indurated  chancre  ;  various  secondary  ac- 
cidents ;  treatment  for  fourteen  weeks,  composed  principally  of 
iodide  of  potassium  ;  but  little  mercury ;  marriage  five  years 
after  debut  of  syphilis  ;  wife  remaining  uninfected  ;  a  healthy 
child,  at  present  fifteen  years  old  ;  fifteen  years  after  marriage, 
tuberculo-ulcerative  syphilide  of  nose. 

Case  LXXXVII. — Indurated  chancre  ;  papular  syphilide  ;  buc- 
cal syphilides  ;  genital  syphilid es  ;  treatment  prolonged  ;  marriage 
nine  years  after  debut  of  disease  ;  wife  remaining  uninfected  ;  a 
healthy  child. 

Independently  of  the  principal  demonstration  fur- 
nislied  by  the  preceding  statistics,  they  bring  into  promi- 
nence a  most  important  fact,  viz.,  that  syphilitic  subjects 
may  be  inoffensive  in  marriage  to  their  wives  and  chil- 
dren, even  while  they  remain  under  the  power  of  the 
diathesis,  and  are  destined  to  undergo  new  attacks.  And, 
in  effect,  these  statistics  embrace  no  less  than  tMrty-five 
cases  of  this  order,  in  which  various  accidents  of  a  nature 
incontestably  specific  occurred  after  marriage,  without, 
however,  the  wives  and  the  children  of  these  different 
patients  having  suffered  the  least  bad  result  medically. 
This  fact  is  certainly  reassuring.  Nevertheless,  one  should 
not  exaggerate  the  importance  of  these  statistics,  nor 
attach  to  them  a  signification  of  which  they  do  not  admit. 
While  it  is  true  that  the  patients  in  question  have  trans- 
mitted, hereditarily,  nothing  to  their  offspring,  and  have 
communicated  nothing  to  their  vdves  (which  is  explained 
by  the  situation  or  the  character  of  their  accidents),  they 
have  no  less  been,  a  certain  number  at  least,  very  preju- 
dicial to  their  families  on  account  of  the  personal  conse- 
quences of  their  disease.  Many,  for  example,  hsive  died  ; 
others  have  only  survived  with  functional  troubles,  more 


NOTES  AND  ILLUSTRATIVE  GASES.  209 

or  less  important,  with  serious  infii-mities,  etc.,  and  that 
to  the  great  detriment  of  the  social  community  constituted 
by  marriage. 

On  the  other  hand,  note  it  well,  the  preceding  statistics 
have  neither  for  object  nor  for  result,  from  the  point  of 
view  of  the  protection  of  wives  and  children,  the  estab- 
lishment of  numerical  relations  between  the  subjects  who 
marry  after  a  sufficient  depuration  and  those  who  contract 
marriage  in  conditions  precisely  opposite.  This  relation 
necessarily  escapes  us,  and  will  always  escape  us.  In 
effect,  we  only  take  cognizance  of  those  patients  who 
come  to  us  on  account  of  various  accidents,  and  these  are 
always  certain  to  find  a  place  in  our  statistics  ;  while  the 
others  remain  unrecognized  by  us,  for  the  excellent  reason 
that,  having  no  further  manifestations  of  syphilis,  they 
have  no  occcasion  to  claim  our  services. 

Finally,  the  preceding  statistics  show  us  certain  exam- 
ples of  syphilis  particularly  grave,  which  have,  never- 
theless, remained  inoffensive  in  marriage,  at  least  so  far 
as  relates  to  the  dangers  incurred  by  the  wife  and  the 
children.  Case  XXIII  is  a  type  of  this  class.  This, 
assuredly,  was  one  of  the  cases  in  which  every  prudent 
physician  would  have  considered  it  his  duty  to  interdict 
marriage,  by  reason  of  the  multiplicity  and  the  threat- 
ening character  of  the  manifestations  (profound  ecthym- 
atous  syphilide  with  multiple  recurrences,  rupia,  the 
most  violent  cephalalgia,  hemiplegia,  etc.).  The  result, 
however,  has  not  justified  the  apprehensions  which  the 
gravity  of  the  symptoms  was  calculated  to  excite. 


NOTE    11. 

SYPHILIS. — SEVEN  ABOETIONS   OR  PREMATURE  ACCOUCHE- 

MENTS. 

X ,  aged  forty  years,  seamstress,  entered  the  Lour- 

cine  Hospital,  June  16,  1870. 

She  is  a  woman  of  tall  figure,  who  aj)pears  to  have 
formerly  had  a  robust  constitution,  but  who  has  become, 
according  to  her  statement,  very  much  enfeebled  by  work, 
grief,  and  numerous  pregnancies. 

She  has  always  enjoyed  excellent  health.  She  even 
boasts  that  she  has  never  suffered,  apart  from  her  con- 
finements, the  least  indisposition. 

Married  at  nineteen  years  of  age,  she,  first  of  all,  had 
three  ''superb  children,"  two  of  which  are  still  living  and 
in  excellent  health.  The  third,  which  was  likewise  well 
developed,  died  in  infancy,  and  appears  to  have  suc- 
cumbed to  some  incidental  malady  of  an  acute  form 
(probably  pneumonia).  At  the  age  of  twenty-nine  years, 
this  woman  contracted  syphUis  from  her  husband,  who 
had  himself  contracted  it  quite  recently.  At  the  same 
time  she  became  enceinte.  This  pregnancy  was  termi- 
nated by  an  abortion  in  the  fifth  month.  As  accidents 
of  syphUis,  the  patient  states  that  she  had,  at  first, 
an  indurated  chancre  of  the  vulva ;  then,  soon  afterward, 
an  eruj)tion  of  small  red  spots,  which  rajDidly  covered  the 
body,    the   limbs,   and   the   lower  portion  of  the  face. 


NOTES  AND  ILLUSTRATIVE  CASES.  211 

Later  she  had  new  papules  on  the  skin,  erosions  in  the 
mouth,  and,  especially,  a  very  tenacious  eruption  on  the 
palms  of  the  hands.  This  eruption  had  been  called  psori- 
asis by  a  physician.     It  continued  not  less  than  a  year. 

On  account  of  these  various  accidents  the  patient 
twice  entered  the  Hospital  St.  Louis,  in  tihe  service  of  Dr. 
Gfibert.  The  second  time  she  remained  nearly  six  months. 
She  remembers  having  been  treated  by  a  mercurial  syrup, 
then  by  a  solution  of  iodide  of  potassium.  Since  then 
she  has  not  had  any  treatment,  although  at  times  she  has 
experienced  new  accidents,  notably  ulcerations  in  the 
mouth,  violent  pains  in  the  arms  and  in  the  back,  diffused 
neuralgias,  and  a  very  characteristic  sciatica. 

She  has  not  been  better  treated,  she  says,  because  she 
has  scarcely  ceased  being  enceinte  since  that  time.  And, 
in  reality,  from  that  date  until  1867,  she  has  had  no  fewer 
than  six  pregnancies,  which  all  terminated  disastrously, 
as  follows : 

Fifth  pregnancy:  premature  accouchement  at  seven 
months  and  a  half ;  child  sickly,  stunted,  dying  on  the 
fifteenth  day. 

Sixth  pregnancy :  accouchement  almost  at  term  ;  child 
stiU-born. 

Seventh  pregnancy  :  premature  accouchement  at  seven 
months  and  a  half ;  child  stUl-born.  The  patient' s  mother, 
who  assisted  at  the  confinement,  said  to  her  that  the 
child's  skin  "was  quite  black  and  came  off  in  pieces." 

Eighth  pregnancy:  premature  accouchement;  child 
still-born. 

Ninth  pregnancy :  abortion  at  three  months  and  a  haK. 

Tenth  pregnancy :  abortion  at  six  weeks,  accompanied 
with  considerable  haemorrhage,  and  followed  by  several 
metrorrhagias. 


212  SYPHILIS  AND  MARRIAGE. 

To  recapitulate,  tlien :  ten  pregnancies,  of  which  the 
three  anterior  to  the  syphilis  resulted,  at  term,  in  healthy- 
children,  and  the  seven  posterior  to  the  syphilis  termi- 
nated in  four  premature  accouchements  and  tliree  abor- 
tions. 

Within  the  last  two  years  new  accidents  again  ap- 
peared, viz.  :  "a  tumor "  at  the  level  of  the  left  clavicle, 
quite  voluminous  and  very  sensitive  to  pressure ;  an 
eruption  of  crusts  on  the  hairy  scalj) ;  an  abundant  loss  of 
hair,  etc.  These  various  accidents  brought  the  patient  to 
Lourcine,  where  she  was  treated  (service  of  Dr.  Pean) 
with  mercurial  pills  and  the  iodide  of  potassium.  She 
left  cured ;  even  her  hair  had  almost  entirely  grown  in 
again. 

Outside,  the  patient  continued  the  medication  for  sev- 
eral months,  returning  from  time  to  time  to  the  hospital 
for  consultation,  where  we  saw  her  for  the  first  time. 

Finally,  about  a  month  ago,  she  felt  two  lumps,  "like 
two  kernels,"  which  were  formed  in  the  tongue.  A  third 
kernel  soon  formed  in  the  neighborhood  of  the  two  others. 
Then  all  three  became  ulcerated,  and  on  this  account  she 
came  to  ask  our  care. 

To-day,  we  find  upon  the  extremity  of  the  tongue 
three  well-circumscribed  ulcerations,  with  borders  adhe- 
rent and  clearly  cut,  with  grayish  bottom,  the  base  en- 
gorged and  renitent.  In  aspect,  they  are  types  of  gum- 
mous  lesions.  No  symptomatic  adenopathy.  No  other 
accidents. 

Treatment :  iodide  of  potassium,  in  a  daily  dose  of  from 
three  to  five  grammes,  progressively  increased  ;  painting 
twice  a  day  with  the  tincture  of  iodine  ;  gargles  of  infu- 
sion of  marsh-mallow,  and  pulverizations  of  iodide  solu- 
tion upon  the  tongue.     Rapid  cure. 


NOTE  III. 

HEEEDITAEY   II^FLUElSrCE   OF   MATERNAL  SYPHILIS. 

"It  may  be  said  very  positiyely,  and  without  any  ex- 
aggeration, that  the  syphilitic  influence  of  the  mother  is 
veritably  pernicious  for  the  foetus."    (Page  63.) 

The  following  statistics,  collected  from  different  sources, 
and  which,  for  reasons  above  mentioned,  I  intentionally 
give  separately,  go  to  establish  this  with  a  numerical  evi- 
dence unfortunately  too  complete : 

I. 

,  The  first  relates  to  syphilitic  women  observed  in  this 
city,  in  private  practice.  It  comprises  eighty-five  cases  of 
pregnancy,  which,  considered  only  in  their  result,  the 
most  direct  and  the  least  subject  to  error,  viz.,  the  deatTi 
or  the  surmval  of  the  child,  have  furnished  me  with  the 
following  figures : 

Cases  of  survival 27 

Cases  of  death  (abortions,  premature  accouchements,  still-born 
infants,  infants  dead  within  a  short  time  after  delivery) . .  58 

Total 85 

Here  are  the  details  of  these  different  cases  : 

Case  I. — X ,  nineteen  years  old  ;  indurated  chancre  of  the 

16 


214:    ■  SYPHILIS  AND  MARRIAGE. 

lip,  misunderstood  as  to  its  nature  ;  papulo-squamous  syphilide  ; 
no  treatment  ;  miscarriage  at  third  month,* 

Case  II. — Twenty-one  years  ;  contagion  at  beginning  of  mar- 
riage ;  roseola  ;  papulo-erosive  syphilides  of  the  vulva  and  anus  ; 
mercurial  treatment  for  some  months  ;  pregnancy  ;  accouche- 
ment at  about  seven  months  ;  child  very  miserable,  dying  on  fifth 
day. 

Case  III. — Twenty-five  years  ;  debut  of  syphilis  unknown  ; 
pregnancy  ;  mercurial  treatment  of  short  duration  ;  accouchement 
at  term ;  child  syphilitic  ;  energetically  treated  and  surviving 
(now  nine  years  old). 

Case  IV. — Twenty-eight  years  ;  debut  of  syphilis  unknown  ; 
various  secondary  accidents  ;  prolonged  treatment  (mercury  and 
iodide  of  potassium);  pregnancy  six  years  after  first  accidents  ; 
accouchement  at  term  ;  child  healthy  and  surviving  ;  two  years 
after  birth  of  child,  superficial  syphilides  of  the  tongue. 

Case  V. — Thirty-one  years  ;  contagion  at  date  of  marriage  ; 
treatment  very  irregular  and  of  short  duration  ;  four  pregnancies 
in  five  years  ;  first  pregnancy  :  accouchement  at  seven  and  a  half 
months,  child  very  small,  cachectic,  born  with  a  specific  eruption, 
and  dying  in  some  hours  ;  the  three  other  pregnancies  were  ter- 
minated by  abortion. 

Case  VI. — Twenty-five  years  ;  husband  syphilitic  ;  pregnancy 
from  beginning  of  marriage  ;  syphilis  by  conception  ;  papulo- 
squamous syphilide ;  vulvar  and  buccal  syphilides ;  mercurial 
treatment  for  some  Aveeks  ;  accouchement  before  term  ;  child  bom 
with  a  syphilitic  eruption  ;  dying  on  eleventh  day. 

Case  VII. — Twenty-one  years  ;  infected  soon  after  marriage 
(syphilis  by  conception  at  least  probable) ;  specific  treatment  long 
time  continued  ;  first  child  syphilitic,  surviving  ;  second  pregnancy 

*  I  shall  only  mention  here,  be  it  well  understocd,  miscarriages  absolutely  sponta- 
neous— I  mean  happening  without  an  accidental  cause,  and  which  could  not  reason- 
ably be  imputed  to  specific  influence.  I  have  rigorously  excluded  from  these  statis- 
tics all  cases  where  there  existed  the  least  suspicion  of  the  possible  action  of  any 
cause  whatever  outside  of  syphilis. 


NOTES  AND  ILLUSTRATIVE  CASES.  215 

terminates  by  abortion  (accidental  causes  alleged);  third  and 
fourth  pregnancies  terminating  at  term  ;  children  healthy  and 
living. 

Case  VIIL— (See  page  117.) 

Case  IX. — Infected  by  her  husband  in  the  last  months  of  first 
pregnancy  ;  vulvar  chancre  ;  roseola  ;  cephalalgia  ;  specific  treat- 
ment quite  prolonged  ;  accouchement  at  term  ;  child  syphilitic, 
dying  in  a  few  hours  ;  second  pregnancy  :  accouchement  at  eight 
months  ;  child  presenting  syphilitic  spots  at  birth  ;  dying  in  half 
an  hour ;  third  pregnancy  :  accouchement  at  term  ;  child  healthy 
in  appearance,  dying  suddenly  of  convulsions  at  seven  months  ; 
fourth  pregnancy  :  accouchement  at  term  ;  child  healthy  ;  surviv- 
ing; fifth  pregnancy  :  accouchement  before  term  ;  child  dying  in 
a  few  hours  ;  sixth  pregnancy  :  abortion  ;  seventh  pregnancy : 
accouchement  at  term  ;  child  healthy  ;  surviving. 

Case  X. — Twenty-three  years  ;  date  of  origin  of  syphilis  un- 
known ;  various  secondary  accidents  ;  treatment  of  some  weeks  ; 
accouchement  at  term  ;  child  syphilitic,  infecting  its  nurse,  and 
dying  at  the  age  of  one  month  ;  second  pregnancy  five  years  later, 
after  prolonged  treatment ;  child  healthy  ;  surviving. 

Case  XI. — Infected  by  her  husband  ;  various  secondary  acci- 
dents ;  treatment  of  short  duration  ;  three  pregnancies  ;  first  child 
dying  at  six  weeks  ;  second  child  dying  in  three  hours  ;  third  child 
still-born  ;  at  this  time  specific  treatment,  which  is  prolonged  sev- 
eral years  ;  fourth  pregnancy  :  child  healthy  ;  surviving. 

Case  XII. — Twenty-one  years  ;  syphilis  dating  back  several 
months  ;  papulo-squamous  syphilide  ;  lingual  syphilides  ;  onyxis  ; 
treatment  two  or  three  months  ;  abortion. 

Case  XIII. — Twenty-eight  years  ;  infected  by  her  husband  ; 
treatment  of  fifteen  days  ;  first  pregnancy  giving  a  syphilitic 
child,  which  dies  in  a  few  hours  ;  the  husband  and  wife  then  sub- 
mit themselves  to  a  specific  treatment,  which  is  pursued  during 
two  years  ;  second  pregnancy  three  years  later ;  child  healthy ; 
surviving. 


216  SYPHILIS  AND  MARRIAGE. 

Case  XIV. — Seventeen  years  ;  vulvar  chancre  ;  papular  sypli- 
ilide  ;  palmar  psoriasis  ;  cephalalgia ;  treatment  short,  in  very 
feeble  doses  ;  pregnancy  in  the  second  year  of  the  disease  ;  ac- 
couchement before  term  ;  child  dying  in  three  weeks,  in  a  state 
of  frightful  consumption. 

Case  XV. — Twenty-seven  years ;  syphilis  in  1869  ;  confluent 
syphilides  of  vulva  ;  buccal  syphilides  ;  treatment  of  a  few  weeks  ; 
premature  accouchement  in  1870  of  dead  child  ;  premature  ac- 
couchement in  1871  ;  child  dead. 

Case  XVI.— (See  page  118.) 

Case  XVII.  —  Twenty-two  years  ;  syphilis  by  conception  ; 
erythemato-papular  syphilide  ;  tonsillar  syphilides  ;  cephalalgia  ; 
treatment  of  some  months  ;  accouchement  at  seven  months  ;  child 
healthy  in  appearance  ;  dies  suddenly  after  some  days. 

Case  XVIII.  —  Twenty-two  years  ;  syphilis  by  conception  ; 
secondary  accidents  toward  the  fifth  month  of  pregnancy  ;  mercu- 
rial treatment  ;  accouchement  at  seven  and  a  half  months  ;  child 
affected  with  grave  syphilis  ;  energetically  treated,  it  survives. 

Case  XIX. — Thirty  years  ;  syphilis  in  1872  ;  chancre  not  rec- 
ognized ;  vulvar  and  buccal  syphilides  ;  alopecia  ;  treatment  of 
some  months  ;  abortion  in  1875. 

Case  XX. — Twenty-five  years  ;  infected  from  the  data  of 
marriage  ;  vulvar  chancres  ;  syphilides  ;  four  months  of  treat- 
ment ;  two  miscarriages  in  the  first  two  years  succeeding  mar- 
riage ;  the  fifth  year,  child  syphilitic  ;  surviving  ;  contamination 
of  the  nurse. 

Case  XXI. — Twenty-nine  years  ;  cutaneous  syphilides  ;  vul- 
var syphilides  ;  treatment  of  some  months  ;  pregnancy  in  the  first 
months  of  the  disease  ;  abortion. 

Case  XXII. — Thirty  years  ;  debut  of  syphilis  unrecognized, 
manifesting  itself  in  the  course  of  pregnancy  ;  papular  syphilide  ; 
palmar  psoriasis  ;  onyxis  ;  treatment  of  few  weeks  ;  accouchement 
at  term  ;  child  dead  fifteenth  day. 

Case  XXIII. — Twenty-nine  years  ;  d^but  of  syphilis  unknown  ; 


NOTES  AND  ILLUSTRATIVE  CASES.  217 

no  treatment ;  papular  syphilide  ;  buccal  syphilides  ;  abortion  ; 
afterward,  periostosis  and  accidents  of  cerebral  syphilis. 

Case  XXIV. — Twenty-two  years  ;  accidents  of  secondary 
syphilis  in  the  course  of  pregnancy  ;  roseola  ;  cephalalgia  ;  in- 
tense neuralgias  ;  retiuo-choroiditis  ;  treatment  of  some  months  ; 
abortion. 

Case  XXV. — Twenty-five  years  ;  indurated  vulvar  chancre  ; 
roseola  ;  lingual  syphilides  ;  treatment  of  some  weeks  ;  pregnancy 
six  months  after  debut  of  disease  ;  abortion. 

Case  XXVI. — Twenty-three  years ;  infected  from  the  d6but 
of  her  marriage  and  became  enceinte  simultaneously  ;  treatment 
of  some  months  ;  accouchement  of  a  dead  child  at  eight  months  ; 
three  pregnancies  the  three  following  years  ;  treatment  of  some 
months  in  the  course  of  each  pregnancy  ;  second  child  syphilitic  ; 
dead  at  two  months  ;  third  child  syphilitic  ;  treated  energetically, 
it  survives  ;  fourth  child  healthy  ;  entirely  well. 

Case  XXVII. — Twenty-two  years  ;  indurated  chancre  of  the 
buttock  in  1870  ;  papular  syphilide  ;  vulvar  and  buccal  syphilides  ; 
frontal  periostitis  ;  ten  months  of  regular  treatment  (mercury  and 
iodide  of  potassium)  ;  accouchement  at  term,  in  December,  1872  ; 
child  healthy. 

Case  XXVIII. — Twenty  years  ;  contagion  in  sixth  month  of 
pregnancy  ;  indurated  vulvar  chancre  ;  tonsillar  syphilides  ;  treat- 
ment only  commenced  at  eighth  month;  five  days  after,  accouche- 
ment of  a  macerated  foetus. 

Case  XXIX. — Nineteen  years  ;  secondary  accidents  appear- 
ing in  the  first  months  of  pregnancy  ;  erythemato-papular  syphi- 
lide ;  vulvar  syphilides  ;  cephalalgia  ;  treatment  of  ten  months  ; 
accouchement  of  a  dead  child. 

Case  XXX. — Twenty  years  ;  secondary  accidents  appearing 
in  third  month  of  pregnancy  ;  treatment  of  some  months  ;  abor- 
tion ;  afterward,  mercurial  and  iodide  treatment  long  time  pur- 
sued ;  second  pregnancy  two  years  later ;  accouchement  at  term  ; 
healthy  child  ;  onyxis  consecutively  to  accouchement. 


218   .  SYPHILIS  AND  MARRIAGE. 

Case  XXXI. — Twenty-seven  years  ;  secondary  accidents  ap- 
pearing in  the  course  of  pregnancy  ;  ti'eatment  of  some  months  ; 
abortion  ;  second  pregnancy  :  premature  accouchement ;  child  dead 
on  fifteenth  day  ;  third  pregnancy  :  accouchement  at  term  ;  child 
syphilitic  ;  treated  ;  surviving. 

Case  XXXII. — Twenty-five  years  ;  debut  of  syphilis  unknown  ; 
not  treated  ;  pregnancy  three  to  four  months  ;  papulo-squamous 
syphilide  ;  ulceration  of  the  tonsils  ;  alopecia  ;  abortion. 

Case  XXXIII* — Twenty-seven  years  ;  debut  of  syphilis  un- 
known ;  no  treatment  ;  pregnancy  from  fourth  month  ;  tonsillar 
syphilides  ;  osteocopic  pains  ;  abortion. 

Case  XXXIV. — Twenty-three  years  ;  secondary  accidents  ap- 
pearing in  the  course  of  pregnancy  ;  no  treatment  ;  abortion. 

Case  XXXY. — Twenty-six  years  ;  syphilis  transmitted  by 
catheterism  of  the  Eustachian  tube,  and  remaining  for  a  long  time 
unrecognized  ;  herpetiform  syphilide  ;  ecthyma,  cephalalgia,  neu- 
ralgias ;  treatment  of  some  months  ;  abortion. 

Case  XXXVI. — Twenty-five  years  ;  syphilis  of  unknown  debut 
and  not  treated  ;  various  secondary  accidents  ;  first  pregnancy  ; 
child  still-born  ;  second  pregnancy :  child  dying  fifteenth  day  ; 
consecutively,  tubercular  syphilide. 

Case  XXXVII.-^Twenty-four  years  ;  roseola  ;  papular  syphi- 
lide ;  buccal  syphilides  ;  treatment  from  five  to  six  months  ;  pregj- 
nancy  in  second  year  of  disease  ;  abortion. 

Case  XXXVIII. — Thirty-one  years  ;  syphilis  not  recognized  ; 
cicatrices  clearly  specific  ;  no  treatment ;  abortion  ;  some  years 
later,  syphilis  of  the  brain  ;  death. 

Case  XXXIX. — Twenty-seven  years  ;  infected  at  beginning 
of  marriage  ;  treatment  of  few  months  ;  two  pregnancies,  termi- 
nating by  abortion  ;  afterward,  gumma  of  palatine  arch  and  per- 
foration of  palate. 

Case  XL. — Twenty-five  years  ;  contagion  in  third  month  of 
pregnancy  ;  indurated  chancre  of  labia  minora  ;  papular  syphi- 
lide ;    treatment  of  one   month  ;   accouchement  at  term  ;    child 


NOTES  AND  ILLUSTRATIVE  GASES.  219 

eyphilitic  ;  treated ;  dying  at  eight  months  ;  treatment  regular  and 
prolonged  after  accouchement  ;  three  years  later,'  second  preg- 
nancy ;  child  healthy,  surviving. 

Case  XLI. — Twenty-three  years  ;  debut  of  syphilis  unknown  ; 
papulo-crusted  syphilide  ;  buccal  syphilides  ;  irregular  treatment ; 
pregnancy  five  years  after  infection  ;  accouchement  almost  at 
term  ;  child  syphilitic,  soon  dying  ;  two  miscarriages  the  two  fol- 
lowing years. 

Case  XLII. — Twenty-two  years  ;  infected  in  second  month  of 
pregnancy  ;  chancre  parchemAn'e,  of  the  vulva  ;  vulvar  syphilides  ; 
mercurial  treatment  until  the  end  of  pregnancy  ;  accouchement  at 
term  ;  child  surviving,  never  having  presented  but  a  slight  erup- 
tion, nature  of  which  remains  doubtful. 

Case  XLIII. — Twenty-three  years  ;  syphilitic  infection  and 
pregnancy  from  debut  of  marriage  ;  no  treatment ;  abortion  at 
second  month. 

Case  XLIY. — Twenty-two  years  ;  pregnancy  from  debut  of 
marriage  ;  accidents  of  secondary  syphilis  appearing  from  the 
third  or  fourth  month  of  gestation  ;  treatment  of  some  months  ; 
accouchement  at  term  ;  child  syphilitic  ;  treated  ;  surviving. 
(This  child  infected  its  nurse,  who  has  transmitted  the  syphilis — 
1.  To  her  child  ;  2.  To  her  husband.) 

Case  XLV. — Twenty-three  years  ;  secondary  accidents  making 
invasion  in  fifth  month  of  pregnancy ;  mercurial  treatment ;  ac- 
couchement at  term  ;  child  syphilitic  ;  treated  ;  surviving ;  con- 
tagion transmitted  to  the  nurse. 

Case  XLYI, — Twenty  years  ;  infected  from  debut  of  mar- 
riage ;  treatment  for  some  weeks  ;  two  abortions  in  the  first  year ; 
recommencement  of  treatment,  which  is  continued  two  and  a  half 
years  ;  pregnancy  four  years  later  ;  accouchement  at  term  ;  child 
healthy  (at  present  five  years  old). 


220  SYPHILIS  AND  MARRIAGE. 

II. 

Our  second  statistics  have  been  recorded  of  patients 
observed  in  hospital  practice,  for  the  most  part  at  the 
Lourcine,  some  at  the  Saint  Louis.  It  has  furnished  us 
the  following  results : 

Cases  of  survival  of  infant 23 

Cases  of  death  of  infant  (abortions,  premature  accoucliements, 
still-born,  children  dead  shortly  after  the  accouchement) . .  145 

Total 167 

• 

Here  are  the  cases  which  have  furnished  the  elements 
of  these  statistics : 

Case  I. — Twenty-seven  years  ;  syphilis  of  unknown  origin  ; 
roseola  and  vulvar  syphilides  in  1872  ;  no  treatment  ;  in  1875, 
accouchement  at  seven  months  ;  child  still-born  ;  in  1879,  tuber- 
cular syphilide,  taking  on  a  phagedenic  form. 

Case  II. — Thirty  years  ;  syphilis  in  1868  ;  cutaneous  erup- 
tions ;  syphilides  of  the  mucous  membranes  ;  alopecia ;  very  short 
treatment  ;  in  1869,  accouchement  at  term  of  a  dead  child  ;  in 
1875,  miscarriage  at  three  months  ;  in  1878,  enormous  gumma  of 
the  sternal  region. 

Case  III. — Twenty-five  years  ;  syphilis  of  unknown  origin, 
but  of  certainly  recent  date  ;  papulo-hypertrophic  syphilide  of  the 
vulva  ;  crusts  of  the  hairy  scalp  ;  very  irregular  treatment ;  abor- 
tion at  fourth  month. 

Case  IV. — Thirty-five  years  ;  in  1877,  syphilis  occurring  in 
the  course  of  pregnancy  ;  papulo-hypertrophic  syphilides  of  the 
vulva  and  the  peringeum  ;  treatment  for  some  months  ;  accouche- 
ment at  term  ;  child  dying  of  convulsions  when  one  month  old ; 
second  pregnancy  in  1878  ;  abortion. 

Case  V, — Twenty-one  years  ;  pregnancy  eight  months  ad- 
vanced ;  genital  and  peri-anal  syphilides  ;  no  treatment  until  en- 


NOTES  AND  ILLUSTRATIVE  CASES.  221 

trance  to  hospital ;  mercurial  treatment  ;  accouchement  at  term  ; 
child  syphilitic  ;  dying  in  five  months. 

Case  YI. — ^Twenty-seven  years  ;  syphilis  probably  hereditary  ; 
tuberculo-ulcerative  syphilide  of  phagedenic  form,  having  com- 
menced when  she  was  eight  years  old,  and  still  persisting  nineteen 
years  later.  This  lesion  has  traversed  the  entire  extent  of  the  in- 
ferior limb,  affecting  a  serpentine  course  ;  cured  quite  rapidly  by 
specific  treatment.  Five  pregnancies.  First  pregnancy,  child  dy- 
ing at  two  and  a  half  years  ;  second  pregnancy,  child  dying  at  six 
months  ;  third  pregnancy,  child  affected  "  with  an  immense  sore, 
which  involved  the  entire  chest " — dying  at  three  years  ;  fourth 
pregnancy,  child  hydrocephalic,  dying  at  five  months  ;  fifth  preg- 
nancy, child  dying  suddenly,  and  "  without  disease,"  at  the  age  of 
three  months. 

Case  VII.  —  Thirty-nine  years  ;  syphilis  unrecognized  ;  in 
1877,  gummous  syphilide  destroying  the  nasal  septum  and  its 
base,  multiple  and  very  large  cicatrices  disseminated  over  the 
whole  body.  The  lesions  which  produced  these  cicatrices  date  back 
fifteen  years.  Two  pregnancies  in  1867  and  1868.  First  child 
dying  at  one  year  (cause  unknown)  ;  second  child  dying  at  three 
weeks,  in  a  state  of  consumption. 

Case  VIII, — Syphilis  at  twenty-five  years  ;  roseola  ;  mucous 
patches,  alopecia,  osteocopic  pains,  febrile  attacks  ;  later,  ulcer- 
ating syphilides  leaving  deep  cicatrices  ;  treatment  irregular. 
First  pregnancy  at  thirty  years  ;  child  syphilitic,  surviving  ;  sec- 
ond pregnancy  the  following  year,  child  surviving ;  five  years 
later,  rupia. 

Case  IX. — Twenty -three  years  ;  in  1874,  pregnancy,  in  the 
course  of  which  appeared  mucous  and  cutaneous  syphilides  ;  ac- 
couchement at  term  ;  child  dying  at  three  months  (cause  unknown) ; 
second  pregnancy  in  1875  ;  abortion  at  three  months  ;  third  preg- 
nancy in  1876  ;  abortion  at  seven  months  ;  treatment  always 
irregular.     Later,  in  1878,  ulcerating  syphilide  of  the  vulva. 

Case  X. — Twenty-five  years  ;  syphilis  unknown ;  gumma  of 


222     ■  SYPHILIS  AND  MAIiRIAGB. 

pharynx  in  1878  ;  the  same  year,  accouchement  before  term,  child 
dying  of  convulsions  on  eighth  day. 

Case  XI.  —  Twenty -nine  years  ;  syphilis  unknown  ;  buccal 
and  vulvar  syphilides  ;  alcoholism  ;  pregnancy  ;  child  submitted 
to  an  energetic  treatment,  surviving. 

Case  XII. — Twenty -two  years  ;  accidents  of  secondary  syphi-. 
lis  in  the  course  of  pregnancy  ;  treatment  very  short  ;  premature 
accouchement ;  child  still-born.  The  following  year,  second  preg- 
nancy ;  accouchement  at  term,  child  dying  in  six  weeks.  The  fol- 
lowing year,  third  pregnancy  ;  accouchement  at  term,  child  dying 
first  day.     Later,  papulo-squamous  syphilide  of  circinate  form. 

Case  XIII. — Twenty-one  years  ;  syphilis  in  1875  ;  contagion 
in  the  course  of  pregnancy  ;  indurated  chancre  of  the  vulva  ;  sec- 
ondary angina  ;  neuralgias  ;  alopecia  ;  no  treatment  ;  abortion  ; 
second  pregnancy  ;  premature  accouchement  of  a  still-born  child. 
In  1878,  tibial  periostosis. 

Case  XIY. — Twenty  years  ;  accidents  of  secondary  syphilis 
appearing  in  course  of  pregnancy  ;  mercurial  treatment  of  two 
and  a  half  months  ;  premature  accouchement ;  child  syphilitic  ; 
dying  on  tenth  day. 

Case  XV. — Twenty-two  years  ;  pregnancy  ;  contagion  at  de- 
but of  pregnancy  ;  chancre  of  neck  of  uterus  ;  roseola ;  vulvar 
syphilides  ;  crusts  of  the  hairy  scalp.;  mercurial  treatment  not 
prolonged  ;  accouchement  before  term  ;  child  still-born. 

Case  XVI. — Eighteen  years  ;  contagion  at  debut  of  preg- 
nancy ;  chancre  of  neck  of  uterus  ;  vulvar  syphilides  ;  roseola  ; 
palmar  psoriasis  ;  treatment  of  a  few  weeks  ;  abortion  at  third 
month. 

Case  XVII. — Twenty-two  years  ;  pregnancy  at  five  and  a 
half  months  ;  indurated  chancre  of  the  vulva  ;  roseola  ;  ti'eat- 
ment  of  a  few  weeks  ;  premature  accouchement ;  child  still-bom. 

Case  XVIII. — Nineteen  years  ;  syphilis  in  1869  ;  chancre  of 
the  uterine  neck  ;  cephalalgia  ;  cranial  periostoses  ;  no  regular 
treatment ;  pregnancy  in  1871 ;  abortion. 


NOTES  AND  ILLUSTRATIVE  CASES  223 

Case  XIX. — Twenty  years  ;  accidents  of  secondary  syphilis 
in  1872  ;  papulo-erosive  syphilides  of  the  vulva  ;  treatment  of  few 
weeks  ;  in  1875,  pregnancy  ;  accouchement  at  term  ;  child  prob- 
ably syphilitic  ;  dying  in  four  months. 

Case  XX. — Twenty-seven  years  ;  debut  of  syphilis  unknowTi ; 
vulvar  syphilides  ;  abortion  three  weeks  before  entrance  into  hos- 
pital. 

Case  XXI. — Seven  abortions  or  premature  accouchements 
(vide  case  in  detail,  p.  210), 

Case  XXII. — Twenty  years  ;  pregnancy,  in  course  of  which 
appeared  various  secondary  accidents  (roseola,  vulvar  syphilides, 
eruptions  of  crusts  of  hairy  scalp,  alopecia)  ;  treatment  of  a  few 
weeks  ;  abortion  at  six  and  a  half  months. 

Case  XXIII. — Twenty  years,  at  the  time  of  entrance  into 
hospital ;  pregnancy  at  eighth  month ;  papulo-hypertrophic  vul- 
var syphilides  ;  roseola  ;  emaciation  ;  alopecia  ;  asthenia  ;  treat- 
ment by  mercurial  frictions  and  iodide  of  potassium  ;  accouche- 
ment at  term  ;  child  syphilitic  ;  dying  at  six  weeks,  in  state  of 
cachexia. 

Case  XXIV. — Eighteen  years  ;  contagion  contemporary  with 
debut  of  pregnancy  ;  papular  syphilide  ;  vulvar  syphilide  ;  treat- 
ment of  six  weeks  ;  abortion  at  six  and  a  half  months. 

Case  XXV.  —  Twenty  -  two  years  ;  pregnancy  at  seventh 
month  ;  debut  of  syphilis  unknown  ;  confluent  vulvar  syphilides  ; 
alopecia  ;  febrile  attacks  ;  mercurial  treatment ;  accouchement  at 
term  ;  child  dying  of  convulsions  at  five  weeks. 

Case  XXVI. — Twenty-six  years  ;  secondary  syphilis  of  recent 
prigin  ;  no  treatment  ;  abortion  at  fourth  month. 

Case  XXVII. — Seventeen  years  ;  pregnancy  of  seven  months  ; 
papulo-ulcerative  syphilides  of  the  vulva  ;  mercurial  treatment  of 
four  weeks  ;  accouchement  at  eighth  month  ;  child  still-born. 

Case  XXVIII. — Twenty-six  years  ;  pregnancy  of  six  months  ; 
syphilis  appearing  to  date  from  four  months  ;  vulvar,  peri-vulvar, 
anal,  genito-crural,  and  buccal  syphilides  ;  circinate  roseola  ;  treat- 


224  SYPHILIS  AND  MARRIAGE. 

ment  of  few  weeks  ;  accouchement  at  eighth  month  ;  child  etill- 
bom. 

Case  XXIX. — Twenty-two  years  ;  pregnancy  of  five  and  a 
half  months  ;  debut  of  syphilis  unknown  ;  papulo-squamous  syph- 
ilide  ;  cephalalgia  ;  rheumatoid  pains  ;  specific  fever  ;  frontal  peri- 
ostosis  ;  enteritis  ;  emaciation  ;  imminence  of  cachexia  ;  tonic  and 
specific  treatment ;  accouchement  at  eight  months,  child  living 
only  two  hours. 

Case  XXX. — Eighteen  years  ;  pregnancy  of  seven  months  ; 
indurated  chancre  of  upper  lip  ;  tonsillar  syphilides  ;  mercurial 
treatment  ;  accouchement  at  term  ;  child  living,  healthy. 

Case  XXXI. — Twenty-one  years  ;  indurated  chancre  of  vulva 
at  fourth  month  of  pregnancy ;  mercurial  treatment ;  abortion  at 
six  months. 

Case  XXXII. — Eighteen  years  ;  pregnancy  of  two  months  ; 
roseola  ;  crusts  of  hairy  scalp  ;  cephalalgia  ;  mercurial  treatment ; 
abortion  at  three  months. 

Case  XXXIII, — Twenty-four  years  ;  syphilis  dating  from 
five  years  ;  treatment  quite  short ;  ulcerating  syphilides  of  the 
vulva  ;  pregnancy  ;  accouchement  at  term,  child  dying  second 
day. 

Case  XXXIV. — Twenty-three  years  ;  syphilis  in  1869  ;  treat- 
ment of  two  to  three  months  ;  in  1871,  pregnancy  ;  simple  chan- 
cres and  suppurating  buboes  ;  papulo-squamous  syphilides  ;  vul- 
var syphilides  ;  accouchement  at  term  ;  child  syphilitic,  dying  on 
the  fifteenth  day. 

Case  XXX'^^. — Eighteen  years  ;  syphilitic  chancre  in  May, 
1868  ;  roseola  ;  no  treatment  ;  accouchement  at  term,  in  June| 
1868,  child  living  only  five  hours. 

Case  XXXVI. — Twenty-four  years  ;  pregnancy  ninth  month  ; 
indurated  vulvar  chancres  ;  cephalalgia  ;  alopecia  ;  accouchement 
at  term,  two  days  after  entrance  into  hospital ;  child  syphilitic  ; 
dying  at  fourth  month. 

Case  XXXVII. — Twenty-two  years ;  pregnancy  ;  contagion 


NOTES  AND  ILLUSTRATIVE  OASES.  225 

during  eiglith  month  ;  syphilitic  chancre  of  the  vulva  ;  mercurial 
treatment ;  accouchement  almost  at  term ;  child  small  but  sur- 
viving (lost  sight  of  when  six  weeks  old). 

Case  XXXVIII. — Twenty-nine  years  ;  secondary  accidents  in 
the  course  of  pregnancy ;  treatment  irregular,  brief  ;  accouche- 
ment at  eight  months,  child  dying  in  six  days. 

Case  XXXIX. — Seventeen  years ;  debut  of  secondary  syphi- 
lis unknown  ;  no  treatment ;  abortion  at  fourth  month. 

Case  XL.  —  Twenty-one  years  ;  pregnancy,  two  to  three 
months  ;  papulo-erosive  vulvar  syphilides  ;  two  months'  treatment ; 
accouchement  at  term ;  child  syphilitic  ;  dying  at  fourth  week. 

Case  XLIc — Thirty  years ;  syphilitic  chancre  at  fifth  month 
of  pregnancy ;  roseola ;  alopecia ;  buccal  syphilides  ;  two  months' 
treatment ;  accouchement  at  seven  and  a  half  months  ;  child  still- 
born. 

Case  XLII. — Twenty-five  years ;  pregnancy,  fifth  month ; 
syphilis  of  unknown  origin  ;  no  treatment  ;  roseola ;  vulvar 
syphilides  ;  abortion  the  second  day  after  entrance  into  hospital. 

Case  XLIII.  —  Twenty  -  two  years  ;  pregnancy  of  eight 
months ;  debut  of  syphilis  unknown ;  genital  syphilides  ;  cu- 
taneous syphilides ;  treatment  of  three  weeks ;  accouchement  at 
term,  child  dying  in  five  days. 

Case  XLIV. — Twenty-two  years ;  accidents  of  secondary 
syphilis  manifesting  themselves  in  the  course  of  pregnancy  ;  vul- 
var syphilides  ;  no  treatment ;  abortion  at  five  and  a  half  months. 

Case  XLV. — Twenty -two  years  ;  pregnancy  of  eight  months  ; 
roseola  ;  vulvar  syphilides  ;  mercurial  treatment ;  accouchement 
at  term  ;  child  small,  emaciated,  dying  at  fifth  day. 

Case  XLVI. — Thirty  years  ;  pregnancy  of  eight  months ; 
secondary  accidents  manifesting  themselves  in  the  second  half  of 
pregnancy ;  vulvar  syphilides  ;  temporal  periostosis  ;  cephalalgia  ; 
asthenia  ;  emaciation  ;  premature  accouchement ;  child  dying  at 
fourth  day. 

Case    XL VII. — Twenty  -  eight    years  ;    pregnancy  of    eight 


226  SYPHILIS  AND  MARRIAGE. 

months  ;  secondary  accidents  happening  during  pregnancy  ;  papu- 
lar syphilides  ;  cephalalgia  ;  neuralgias  ;  analgesia  ;  no  serious 
treatment ;  accouchement  at  term ;  child  dying  day  of  its 
birth. 

Case  XLVIII. — Twenty-six  years  ;  accidents  of  secondary 
syphilis  occurring  in  second  half  of  pregnancy  ;  vulvar  syphilides  ; 
treatment  of  a  few  weeks  ;  accouchement  at  seven  and  a  half 
months  ;  child  miserable,  dying  in  a  few  hours. 

Case  XLIX. — Twenty-seven  years  ;  debut  of  secondary  syph- 
ilis unknown  ;  cutaneous  syphilides  ;  vulvar  and  buccal  syph- 
ilides ;  no  serious  treatment ;  accouchement  almost  at  term ; 
child  syphilitic,   dying  fifteenth  day. 

Case  L. — Twenty-three  years  ;  debut  of  syphilis  unknown  ; 
vulvar  syphilides  ;  treatment  of  few  weeks  ;  abortion  at  six  and  a 
half  months. 

Case  LI. — Nineteen  years  ;  accidents  of  secondary  syphilis 
appearing  in  the  earlier  months  of  pregnancy  ;  mercurial  treat- 
ment and  iodide  in  small  doses  ;  accouchement  at  term ;  child 
probably  syphilitic,  dying  at  one  month. 

Case  LII. — Nineteen  years  ;  indurated  chancre  of  vulva  in 
fourth  month  of  pregnancy  ;  vulvar  syphilides  ;  specific  treat- 
ment ;  accouchement  at  term  ;  child  dying  in  four  days. 

Case  LIII. — Twenty  years  ;  debut  of  syphilis  unknown  ;  mul- 
tiple secondary  accidents  ;  no  treatment  ;  accouchement  at  seven 
months  ;  child  dying  at  two  months  (probably  syphilitic). 

Case  LIV. — Twenty-two  years ;  syphilis  in  1869,  toward  the 
end  of  first  pregnancy  ;  treatment  of  fifteen  days  ;  child  healthy, 
surviving  ;  in  1872  second  pregnancy  ;  abortion  at  six  months  ; 
later,  gummous  syphilide. 

Case  LV. — Twenty-five  years  ;  debut  of  syphilis  unknown  ; 
secondary  accidents  ;  pregnancy  ;  hydramnios  ;  accouchement  at 
seven  months  ;  child  still-born. 

Case  LVI. — Twenty  years  ;  accidents  of  secondary  syphilis 
coincident  with  debut  of  pregnancy  ;  vulvar  syphilides  ;  crusts  of 


NOTES  AND  ILLUSTRATIVE  CASES.  227 

hairy  scalp  ;  treatment  of  two  montlis  ;  accouchement  at  term  ; 
child  small,  miserable,  dying  in  twenty-four  hours. 

Case  LVII. — Twenty-one  years  ;  debut  of  secondary  syphilis 
unknown  ;  pregnancy  of  seven  months  ;  treatment  of  few  weeks  ; 
accouchement  of  dead  child. 

Case  LVIII. — Nineteen  years  ;  pregnancy  of  five  months  ; 
secondary  syphilis  appearing  to  date  from  two  to  three  months  ; 
treatment  of  a  few  weeks  ;  abortion. 

Case  LIX, — Twenty  years  ;  pregnancy  of  seven  and  a  half 
months  ;  debut  of  syphilis  unknown  ;  vulvar  and  tonsillar  syphi- 
lides  ;  cephalalgia ;  neuralgiform  pains  ;  pigmentary  syphilide  of 
the  neck  ;  treatment  of  a  few  weeks  ;  accouchement  at  term ; 
child  dying  in  few  hours. 

Case  LX. — Twenty-four  years  ;  pregnancy  of  eight  months  ; 
debut  of  syphilis  unknown ;  vulvar  syphilides  ;  no  treatment ; 
child  still-born. 

Case  LXI. — Twenty-four  years  ;  pregnancy  of  eight  months  ; 
syphilis  appearing  to  date  back  three  months  ;  vulvar  syj)hilides  ; 
febrile  attacks  ;  treatment  of  one  month  ;  accouchement  at  term  ; 
child  syphilitic,  treated,  surviving. 

Case  LXII. — Twenty-three  years  ;  pregnancy  in  fourth  month 
of  syphilis  ;  vulvar  syphilides  ;  cephalalgia ;  no  treatment ;  pre- 
mature accouchement  ;  child  still-born. 

Case  LXIII. — Twenty-two  years  ;  pregnancy  of  six  months  ; 
contagion  during  pregnancy  ;  roseola  ;  confluent  syphilides  of  the 
vulva,  of  the  perinseum,  of  the  anus,  of  the  genito-crural  fold ; 
emaciation  ;  no  treatment ;  abortion. 

Case  LXIV. — Twenty  years  ;  pregnancy  of  from  four  to  five 
months  ;  debut  of  syphilis  unknown  ;  confluent  syphilides  of  the 
vulva,  of  the  anus,  of  the  mouth  ;  chloro-an£emia  ;  cephalalgia ; 
analgesia  ;  treatment  very  short  and  irregular ;  accouchement  at 
seventh  month  ;  child  dying  in  twelve  days. 

Case  LXV. — Twenty  years  ;  pregnancy  of  six  months  ;  sec- 
ondary accidents  appearing  during  pregnancy  ;  confluent  syphi- 


228  SYPHILIS  AND  MARRIAGE. 

lides  of  the  vulva  ;  palmar  psoriasis  ;  papulo-squamous  syphilide  ; 
active  mercurial  treatment  (from  five  to  twenty  grammes  of  the 
proto-iodide  daily  during  three  months)  ;  accouchement  at  term  ; 
child  living,  apparently  healthy  (lost  sight  of  when  twelve  days 

oia). 

Case  LXVI. — Twenty  years  ;  secondary  syphilis  of  recent 
date ;  syphilides  of  the  vulva  and  of  the  throat ;  pregnancy  ;  no 
treatment ;  accouchement  almost  at  term  ;  child  syphilitic,  dying 
of  convulsions  when  three  weeks  old. 

Case  LXVII. — Forty-four  years  ;  syphilis  coinciding  with 
debut  of  pregnancy  ;  papulo-hypertrophic  syphilides  of  the  vulva 
and  of  the  anus  ;  buccal  syphilides  ;  alopecia  ;  papulo-squamous 
syphilide,  herpetiform  at  several  points  ;  no  treatment ;  abortion 
at  six  months. 

Case  LXVIII. — Twenty-two  years  ;  syphilis  appearing  at  the 
debut  of  pregnancy ;  multiple  secondary  accidents ;  treatment 
of  two  to  three  months  ;  accouchement  at  term ;  child  still- 
born. 

Case  LXIX. — Nineteen  years  ;  appearance  of  secondary  acci- 
dents in  the  third  month  of  pregnancy  ;  no  treatment ;  accouche- 
ment at  seven  months  ;  child  still-born. 

Case  LXX. — Twenty-six  years  ;  indurated  vulvar  chancre  ap- 
peai'ing  at  third  month  of  pregnancy  ;  treatment  of  from  two  to 
three  months  ;  accouchement  at  seven  and  a  half  months  ;  child 
still-born. 

Case  LXXI. — Twenty  years  ;  pregnancy  of  five  months  ;  d6- 
but  of  secondary  syphilis  unknown  ;  vulvar  syphilides  ;  syphilitic 
fever  ;  costal  periostitis  ;  treatment  of  a  few  months  ;  accouche- 
ment at  term ;  child  still-born. 

Case  LXXII. — Twenty-one  years ;  contagion  at  third  month 
of  pregnancy  ;  indurated  chancre  of  the  vulva  ;  vulvar  syphilides  ; 
treatment  of  a  few  weeks  ;  abortion. 

Case  LXXIII. — Nineteen  years  ;  debut  of  syphilis  unknown  ; 
papulo-squamous  syphilide  ;  alopecia  ;  tonsillar  syphilides  ;  treat- 


ROTES  AND  ILLUSTRATIVE  OASES.  229 

ment  for  several  months  ;  accouchement  at  term  ;  child  syphilitic, 
dying  in  three  weeks. 

Case  LXXIV. — Twenty-six  years  ;  debut  of  syphilis  un- 
known ;  papular  syphilide ;  vulvar  syphilides  of  circinate  form  ; 
cephalalgia  ;  pregnancy  ;  treatment  not  prolonged  ;  abortion. 

Case  LXXV. — Twenty  years  ;  pregnancy  of  four  or  five 
months  ;  debut  of  syphilis  unknown  ;  secondary  accidents  ;  treat- 
ment of  a  few  weeks  ;  premature  accouchement ;  child  dying  at 
five  days. 

Case  LXXVI. — Twenty-two  years  ;  contagion  in  the  first 
months  of  pregnancy  ;  vulvar,  anal,  and  tonsillar  syphilides  ;  cepha- 
lalgia ;  mercurial  treatment  prolonged  several  months  ;  accouche- 
ment at  term  ;  child  healthy  (lost  sight  of  when  six  weeks  old). 

Case  LXXYII. — Twenty  years  ;  pregnancy  ;  debut  of  syphi- 
lis unknown  ;  pustulo-crustaceous  syphilide  ;  no  treatment  ;  ac- 
couchement at  seven  months  ;  child  dying  when  five  days  old. 

Case  LXXYIII. — Twenty-one  years  ;  syphilis  dating  from 
eighteen  months  ;  mercurial  and  iodide  treatment  quite  regularly 
followed  and  long  protracted  ;  accouchement  at  term  in  the  second 
year  of  the  disease  ;  child  living  and  healthy. 

Case  LXXIX. — ^Twenty-two  years  ;  debut  of  syphilis  un- 
known ;  no  treatment  ;  abortion  at  two  months. 

Case  LXXX.  —  Twenty-eight  years  ;  syphilis  dating  from 
eleven  years  ;  treatment  very  insufiicient  ;  three  pregnancies  since 
the  debut  of  the  disease  ;  three  abortions — at  six  weeks,  at  six 
months,  at  seven  months. 

Case  LXXXI. — Twenty-four  years  ;  debut  of  secondary  syph- 
ilis unknown  ;  vulvar  syphilides  ;  cephalalgia  ;  no  treatment  ; 
abortion  at  two  months. 

Case  LXXXII.  —  Twenty-two  years  ;  secondary  accidents 
making  invasion  in  the  course  of  pregnancy  ;  cutaneous  and  mu- 
cous syphilides  ;  mercurial  treatment  of  several  months  ;  accouche- 
ment at  term  ;  child  syphilitic,  dying  at  two  months. 

Case  LXXXIII. — Twenty-five  years  ;  pregnancy  of  three  to 
16 


230  SYPHILIS  AND  MARRIAGE. 

four  months  ;  debut  of  syphilis  unknown  ;  roseola  ;  palmar  psori- 
asis ;  vulvar  and  peri-vulvar  syphilides  ;  cephalalgia  ;  neuralgic 
pains  ;  febrile  attacks  ;  treatment  of  a  few  months  ;  premature 
accouchement  ;  child  still-born. 

Case  LXXXIV. — Nineteen  years  ;  pregnancy  ;  debut  of  syph- 
ilis unknown  ;  confluent  vulvar  syphilides  ;  papulo-squamous  syph- 
ilide  ;  cephalalgia  ;  nervous  troubles  ;  no  treatment  ;  accouche- 
ment at  seven  months  ;  child  still-born. 

Case  LXXXV. — Thirty-five  years  ;  debut  of  syphilis  not 
known,  certainly  dating  back  from  a  distant  period  ;  multiple 
gummous  tumors  ;  five  pregnancies  ;  four  children  dying,  all  soon 
after  birth  ;  last  child  surviving. 

Case  LXXXVI.  —  Twenty-two  years  ;  pregnancy  of  seven 
months  ;  secondary  syphilis,  debut  unknown  ;  cutaneous  syphi- 
lides ;  vulvar  and  buccal  syphilides  ;  analgesia  ;  treatment,  nature 
unknown,  regularly  followed  during  several  months  ;  accouche- 
ment at  term  ;  child  dying  on  fifteenth  day. 

Case  LXXXVII. — Twenty-two  years  ;  pregnancy  of  four  to 
five  months  ;  syphilis  dating  from  fourteen  months  ;  vulvar  syph- 
ilides ;  treatment  of  some  months  ;  accouchement  at  term  ;  child 
dying  at  twenty  days. 

Case  LXXXVIII. — Eighteen  years  ;  accidents  of  secondary 
syphilis  coinciding  with  debut  of  pregnancy  ;  treatment  of  one 
month  ;  papulo-hypertrophic  syphilides  of  the  vulva  ;  accouche- 
ment at  term  ;  child  still-born. 

Case  LXXXIX. — Twenty-four  years  ;  secondary  syphilis,  d^- 
but  unknown  ;  no  treatment  ;  abortion. 

Case  XC. — Twenty-seven  years  ;  secondary  accidents  appear- 
ing toward  the  sixth  month  of  pregnancy  ;  no  treatment  ;  ac- 
couchement at  term  ;  child  still-bom. 

Case  XCI. — Nineteen  years  ;  secondary  syphilis,  debut  un- 
known ;  no  treatment ;  abortion  at  five  months. 

Case  XCII. — Twenty-eight  years  ;  secondary  syphilis,  debut 
unknown  ;  pregnancy  of  five  months  ;  no  treatment ;  abortion. 


NOTES  AND  ILLUSTRATIVE  CASES.  231 

Case  XCIII. — Twenty-three  years  ;  pregnancy  of  six  months  ; 
secondary  syphilis,  debut  unknown  ;  vulvar  and  anal  syphilides  ; 
treatment  of  some  months  ;  accouchement  at  term  ;  child  still- 
born. 

Case  XCIV. — Thirty-three  years  ;  pregnancy  of  three  months  ; 
vulvar  syphilides  ;  papulo-squamous  syphilide  ;  palmar  psoriasis  ; 
no  treatment ;  abortion  at  six  months. 

Case  XCV. — Twenty-two  years  ;  secondary  accidents  appear- 
ing toward  the  fifth  month  of  pregnancy  ;  vulvar,  peri- vulvar,  and 
anal  syphilides,  etc.;  palmar  psoriasis  ;  alopecia  ;  treatment  of  a 
few  months  ;  accouchement  at  term  ;  child  living,  lost  sight  of 
when  fifteen  days  old. 

Case  XCVI. — Nineteen  years  ;  secondary  syphilis,  debut  un- 
known ;  ulcerating  syphilides  of  the  vulva  ;  palmar  psoriasis  ;  no 
treatment  ;  abortion  at  six  months. 

Case  XCYII. — Twenty  years  ;  syphilitic  chancre  of  the  vulva 
in  the  fifth  month  of  pregnancy  ;  roseola  ;  buccal  syphilides  ;  in- 
terdigital  syphilides  ;  cephalalgia ;  mercurial  treatment  of  four 
months  ;  accouchement  at  term  ;  lost  sight  of  after  four  or  five 
weeks. 

Case  XCVIII.  —  Twenty-four  years  ;  pregnancy  of  three  to 
four  months  ;  debut  of  syphilis  unknown  ;  vulvar,  anal,  and  buccal 
syphilides  ;  treatment  of  some  months  ;  accouchement  at  term  ; 
child  syphilitic  ;  lost  sight  of  when  two  months  old. 

Case  XCIX.  —  Twenty-two  years ;  pregnancy  of  about  five 
months  ;  syphilis  dating  from  one  year  ;  vulvar,  peri-vulvar,  and 
anal  syphilides  ;  treatment  of  several  months  ;  accouchement  at 
term  ;  child  syphilitic,  surviving. 

Case  C. — Twenty-eight  years  ;  contagion  during  pregnancy  ; 
vulvar  syphilides  ;  alopecia  ;  treatment  not  prolonged  ;  accouche- 
ment at  term  ;  child  dying  at  two  months. 

Case  CI. — Twenty-three  years  ;  secondary  syphilis,  debut  un- 
known ;  no  treatment  ;  abortion  at  two  and  a  half  months. 

Case  CII. — Twenty -nine  years  ;  secondary  syphilis  appearing 


232      -  SYPHILIS  AND  MARRIAGE. 

in  the  second  half  of  pregnancy  ;  papulo-squamous  syphilides  ; 
buccal  and  vulvar  syphilides  ;  febrile  attacks  ;  mercurial  treatment 
until  the  end  of  pregnancy  ;  accouchement  at  term  ;  child  syphi- 
litic; treated,  surviving. 

Case  CIII.  —  Twenty  years  ;  secondary  syphilis,  debut  un- 
known ;  vulvo-anal  and  buccal  syphilides ;  treatment,  nature  un- " 
known  ;  accouchement  at  term  ;  child  surviving. 

Case  CIV. — Twenty-one  years  ;  accidents  of  secondary  syphi- 
lis appearing  in  the  second  half  of  pregnancy  ;  vulvar  and  buccal 
syphilides  ;  treatment  of  fifteen  days  ;  accouchement  at  term  ; 
child  still-born. 

Case  CY. — Twenty-four  years  ;  pregnancy  of  eight  months 
and  a  half  ;  debut  of  syphilis  unknown  ;  palmar  psoriasis  ;  treat- 
ment for  several  months  ;  child  healthy,  surviving. 

Case  CVI. — Twenty  years  ;  pregnancy  of  three  months  ;  indu- 
rated chancre  of  the  vulva  ;  papular  syphilide  ;  genital  syphilides  ; 
febrile  attacks  ;  treatment  of  from  two  to  three  months  ;  abortion. 

Case  CVII. — Twenty-one  years  ;  syphilis  dating  from  eight 
months ;  pregnancy  of  four  months ;  erythemato-papular  syphi- 
lide ;  vulvo-anal  syphilides  ;  treatment  of  ten  days  ;  abortion  at 
five  and  a  half  months. 

Case  CVIII. — Twenty-three  years;  pregnancy  of  three  months; 
syphilis  dating  from  two  years  ;  papular  syphilide  ;  vulvar  and 
buccal  syphilides  ;  irregular  treatment ;  accouchement  at  eight 
months  ;  child  dying  in  seventeen  hours. 

Case  CIX. — Twenty-two  years  ;  syphilitic  chancre  of  the  neck 
of  the  uterus  in  the  seventh  month  of  pregnancy  ;  mercurial  treat- 
ment ;  accouchement  at  terra  ;  child  healthy  (at  least  up  to  its  exit 
from  the  hospital,  six  weeks  old). 

Case  CX. — Twenty  years  ;  infected  from  the  d^but  of  mar- 
riage ;  indurated  chancre  of  the  lip ;  roseola  ;  vulvar  and  buccal 
syphilides;  cephalalgia ;  neuralgic  pains  ;  treatment  of  several 
months  ;  accouchement  at  term  (ten  months  after  marriage) ;  child 
syphilitic,  dying  at  one  month. 


NOTES  AND  ILLUSTRATIVE  CASES.  233 

Case  CXI. — Twenty-three  years  ;  debut  of  pregnancy  and  sec- 
ondary accidents  of  syphilis ;  roseola  ;  buccal  syphilidfes  ;  treat- 
ment very  irregular  ;  accouchement  at  eight  months  ;  child  still- 
born. 

Case  CXII,  —  Twenty-live  years  ;  secondary  syphilis,  debut 
unknown  ;  vulvar  syphilides  ;  palmar  psoriasis  ;  pregnancy  of  four 
months  ;  treatment  of  six  weeks  ;  abortion. 

Case  CXIII.  —  Twenty  years  ;  contagion  toward  the  third 
month  of  pregnancy  ;  syphilitic  chancres  ;  roseola  ;  cephalalgia ; 
nervous  phenomena ;  analgesia ;  peripheric  algiditis ;  losses  of 
consciousness  ;  febrile  attacks  ;  mercurial  and  iodide  treatment, 
very  active  and  prolonged  during  the  entire  pregnancy  ;  accouche- 
ment at  term  ;  child  healthy  ;  six  months  after  accouchement  the 
mother  presented  some  papulo-circinate  syphilides  upon  the  legs. 

Case  CXIV. — Twenty  years  ;  pregnancy  ;  debut  of  syphilis 
unknown  ;  cutaneous  and  mucous  syphilides  ;  treatment  of  some 
weeks  ;  abortion  at  three  months  ;  one  year  later  second  preg- 
nancy ;  child  syphilitic,  dying  at  five  months. 

Case  CXV. — Twenty-two  years  ;  pregnancy  of  six  to  seven 
months  ;  debut  of  syphilis  unknown  ;  vulvar  and  buccal  syphi- 
lides ;  roseola  ;  analgesia  ;  two  or  three  months'  treatment ;  ac- 
couchement at  term  ;  child  syphilitic  ;  treated,  surviving ;  con- 
tamination of  the  nurse  by  the  child  ;  syphilis  of  the  nurse  very 
severe. 

Case  CXYI. — Twenty-two  years  ;  chancre  of  the  breast  trans- 
mitted by  a  syphilitic  nursling  ;  cutaneous  syphilides  ;  viilvar 
and  buccal  syphilides  ;  treatment  of  some  weeks  ;  pregnancy  a  few 
months  later  ;  accouchement  at  term  ;  child  syphilitic,  dying  at 
five  weeks. 

Case  CXVII. — Nineteen  years  ;  infected  in  the  first  months 
of  marriage  in  the  course  of  pregnancy  ;  treatment  of  a  few  weeks 
only ;  abortion. 

Case  CXVIII. — Twenty-one  years  ;  syphilis  by  conception  ; 
secondary  accidents  ;  treatment  of  some  weeks  ;  accouchement  at 


23-i  SYPHILIS  AND  MARRIAGE. 

term  ;  child  probably  syphilitic  ;  dying  of  convulsions  when  one 
month  old. 

Case  CXIX.  —  Thirty-one  years  ;  two  children  living  and 
healthy,  born  before  the  contagion  ;  contagion  in  the  course  of  the 
third  pregnancy  ;  treatment  of  some  weeks  at  its  debut,  and  since 
then  no  medication  ;  child  still-born  ;  afterward  four  pregnancies, 
from  year  to  year  ;  three  giving  children  still-born,  or  dying  after 
a  few  days  ;  of  the  fourth  only,  child  surviving,  feeble,  but  ap- 
pearing to  have  never  been  affected  with  specific  accidents. 

Case  CXX. — Twenty-eight  years  ;  contagion  one  year  after 
marriage ;  multiple  secondary  accidents  ;  cutaneous  and  mucous 
syphilides  ;  crusts  of  the  hairy  scalp  ;  alopecia  ;  neuralgic  pains  ; 
cephalalgia,  etc.  ;  treatment  insignificant ;  six  pregnancies  in  four 
years  ;  six  abortions. 

Case  CXXI. — Twenty-nine  years  ;  pregnancy  of  five  to  six 
months  ;  debut  of  syphilis  unknown  ;  secondary  accidents  ;  treat- 
ment of  some  weeks  ;  accouchement  at  eight  months  ;  child  still- 
born. 

Case  CXXII. — Seventeen  years ;  syphilis  recent,  and  preg- 
nancy of  two  or  three  months  ;  vulvar,  anal,  perineal,  and  ton- 
sillar syphilides  ;  crusts  of  the  hairy  scalp  ;  no  treatment ;  abor- 
tion a  few  days  after  entrance  into  hospital. 

Case  CXXIII. — Twenty-one  years  ;  pregnancy  of  five  months  ; 
debut  of  syphilis  unknown  ;  papular  syphilide  ;  vulvar  and  buccal 
syphilides  ;  treatment  of  two  to  three  months  ;  accouchement  al- 
most at  term  j  child  syphilitic,  dying  at  three  weeks. 

Case  CXXIV. — Thirty  years  ;  chancre  in  the  fourth  month  of 
pregnancy;  cutaneous  syphilides;  alopecia;  vulvar  syphilides;  treat- 
ment of  some  weeks  ;  accouchement  before  term  ;  child  still-bom. 

Case  CXXV. — Twenty-seven  years  ;  debut  of  syphilis  un- 
known ;  palmar  psoriasis  ;  tonsillar  syphilides  ;  vulvar  and  peri- 
neal syphilides  ;  alopecia  ;  treatment  very  irregular  ;  four  preg- 
nancies in  two  years  succeeding  invasion  of  syphilis ;  four  abor- 
tions from  two  to  four  months. 


NOTES  AND  ILLUSTRATIVE  GASES.  235 

Case  CXXVI. — Twenty-five  years  ;  syphilis  dating  from  seven 
months ;  pregnancy  of  five  months  ;  cutaneous  syphilides ;  no 
treatment ;  abortion  two  days  after  entrance  into  hospital. 

Case  CXXYII. — Twenty-two  years  ;  syphilis  contracted  at 
beginning  of  marriage  ;  no  treatment ;  abortion  at  three  months  ; 
secondary  accidents  ;  papular  syphilide  ;  buccal  syphilides  ;  vulvar 
syphilides ;  treatment  of  a  few  weeks  ;  the  following  year,  abor- 
tion at  five  months. 


ISrOTE  IV. 

SYPHILIS    COISTTEACTED    BEFORE    MARRIAGE,    AND    MAKING 
ITS  FIRST  APPEARANCE  AFTER  MARRIAGE. 

The  ordinary  period  of  syphilitic  incubation  some- 
times exemplifies  the  curious  fact  of  a  syphilis  which, 
contracted  lief  ore  marriage,  does  not  make  its  first  inva- 
sion until  after  marriage. 

Cases  of  this  kind  are  naturally  quite  rare.  But, 
nevertheless,  I  have  the  records  of  four  which  are  quite 
authentic.     The  following  will  serve  as  an  example  : 

M ,  aged  twenty-eight  years ;  good  constitution ; 

had  typhoid  fever  at  the  age  of  fourteen  years.  Nothing 
else,  besides  this,  than  passing  indispositions.  In  the  way 
of  venereal  accidents,  had  two  blenorrhagias,  at  twenty- 
two  and  twenty-four  years  of  age  ;  perfectly  cured. 

Fifteen  days  before  the  date  fixed  for  his  marriage, 

M gave  a  large  supper  to   his  friends,   under  the 

pretext  of  bidding  adieu  to  bachelor  life.  Stupefied  by 
copious  libations,  he  allowed  himself  to  be  induced  to 
spend  the  night  with  a  former  mistress.  This  woman  was 
at  the  time  under  treatment  for  accidents  of  secondary 
syphilis,  and  still  presented  certain  ^'■houtons^^  on  the 
vulva,  which  her  physician  had  characterized  (I  subse- 
quently learned)  as  mucous  patches.  Afterward,  I  had 
occasion  to  see  this  patient  several  times,  and  observed 
undoubted  accidents  of  syphilis  upon  her. 


NOTES  AND  ILLUSTRATIVE  GASES.  237 

M marries    in    a    perfect    condition    of    health. 

Fifteen  days  after  his  nuptials,  he  observes  upon  the 
glando-preputial  furrow  a  slight  redness,  somewhat  ero- 
sive. He  gives  it  no  further  attention,  believing  it  to  be 
"an  excoriation  from  intercourse  with  his  wife."  His 
sexual  relations  are  not  interrupted.  Still,  the  erosion 
exists ;  it  becomes  enlarged,  and  seems  to  become  tume- 
fied at  its  borders.  Cauterization  with  mnaigre  de  Bully, 
and  continuation  of  his  sexual  relations.  Some  days  later 
only  does  M become  uneasy,  and  consult  his  phy- 
sician, who  expresses  to  him  the  liveliest  fears  as  to  the 
nature  of  the  accident.  Frightened,  he  rushes  to  me,  and 
I  note  the  following  condition :  Upon  the  glando-prepu- 
tial furrow  a  superficial  erosion,  oval-shaped,  of  the  di- 
ameter of  a  lentil ;  surface  smooth,  reddened,  gray  in  the 
center,  lardaceous,  pseudo-membranous ;  borders  adhe- 
rent, slightly  elevated  ;  base  renitent,  hard,  of  a  dry  hard- 
ness, almost  characteristic.  A  single  ganglion  in  the 
corresponding  groin,  hard  and  indolent.  I  confirm  the 
diagnosis  of  my  confrere,  and  I  consider  myself  author- 
ized in  declaring  to  the  patient  that  the  lesion  with  w^hich 
he  is  affected  is  a  sypMUtic  chancre,  resulting  from  a 
contagion  dating  back  several  weeks. 

The  following  days,  the  characteristics  of  this  lesion 
become  more  accentuated.  The  sore  extends,  and  the 
induration,  especially,  becomes  exuberant,  cartilaginous. 
Several  glands  become  implicated,  constituting  a  verita- 
ble inguinal  pleiad.  The  syphilitic  infection  is  then  ab- 
solutely manifest. 

I^^ot  until  this  tmie  does  the  patient  avow  to  me  his 
experience,  and  bring  the  woman  to  me  with  whom  he  had 
connection  several  days  before  his  marriage.  The  veri- 
fication of  the  syphilis  in  this  woman  and  the  details 


238  SYPHILIS  AND  MARRIAGE. 

wliicli  she  gives  in  regard  to  her  disease  complete  and 
confirm  the  diagnosis  of  my  patient's  lesion. 

Six  weeks  later,  the  patient's  body  is  covered  with  a 
roseola.  Afterward,  tonsillar  syphilides,  crusts  of  the 
hairy  scalp,  slight  alopecia,  cervical  adenopathies ;  mer- 
curial treatment ;  disappearance  of  the  accidents. 

The  wife  of  this  patient  would  not  at  first  consent  to 
an  examination  which  her  husband  had  suggested  under 
some  pretext  or  other.  Consequently,  I  did  not  see  her 
until  about  two  months  and  a  half  after  her  marriage. 
At  this  time  there  remained  no  trace  of  vulvar  accidents. 
But  the  patient  stated  that  she  had  had  a  slight  "excori- 
ated pimple  "  some  weeks  previous,  which  had  ]produced 
"some  swelling"  of  the  labia;  and  on  examination  there 
was  found  in  the  groin,  on  the  same  side  as  this  lesion,  a 
ganglionic  pleiad  very  markedly  accentuated,  and  leaving 
scarcely  a  doubt  of  a  syphilitic  infection  of  recent  date. 

A  fortnight  later,  the  patient  complained  of  general 
lassitude,  headache,  vague  pains  in  the  limb.  Then,  a 
roseola  soon  manifested  itself,  which  dissipated  all  uncer- 
tainty as  to  the  situation. 

Subsequently,  palmar  psoriasis,  tonsillar  syphilides, 
alopecia. 

To  recaioitulate,  then : 

1.  Fifteen  days  hefore  mamage,  connection  with  a  wo- 
man affected  with  vulvar  syphilides. 

2.  Marriage  in  apparently  perfect  condition  of  health. 

3.  Fifteen  days  after  marriage,  appearance  of  a  syph- 
ilitic chancre,  followed  by  secondary  accidents,  after  the 
normal  incubation. 

4.  Contamination  of  the  young  wife  from  the  chancre 
of  the  husband,  the  nature  of  which  chancre  was  unrecog- 
nized at  its  origin. 


NOTES  AND  ILLUSTRATIVE  GASES  239 

My  other  three  cases  are,  so  to  speak,  reproductions  of 
the  one  just  narrated.  They  all  relate  to  chancres  break- 
ing out  after  marriage,  as  a  consequence  of  a  contagion 
preceding  the  marriage  from  eight  to  seventeen  days. 
Three  times  in  four,  the  young  wives  contracted  the  con- 
tagion, and  the  fourth  only  escaped,  thanks  to  the  acci- 
dent of  a  quite  prolonged  indisposition,  which  suspended 
all  intercourse.  In  every  case,  in  iine,  the  long  duration 
of  the  incubation  deceived  the  husbands  as  to  the  nature 
of  the  accidents,  and  exposed  them  to  the  risk  of  infecting 
their  wives.  ( 


NOTE  V. 

PREMATURE  MARRIAGE  OF  A  SYPHILITIC  SUBJECT  ;  FIVE 
CASES  OF  SYPniLIS  ORIGHSTATING  FROM  THE  SYPHILIS 
OF  THE  HUSBAIfD  ;    DEATH   OF  A   STRANGE  NURSLING. 

The  f oEowing  case  is  interesting  in  two  respects :  On 
the  one  hand,  it  shows  in  a  general  way  what  may  be  the 
consequences  of  a  premature  marriage  in  syphilis ;  on 
the  other  hand,  it  illustrates  the  dangers  incidental  to  the 
raising  of  a  syphilitic  infant,  when  this  infant  has  been 
committed  to  a  nurse  instead  of  being  suckled  by  its 
mother. 

I.    ]Sr contracts  syphilis.     At  first  he  is  treated 

by  a  pharmacist,  who  gives  him  pills  of  a  "secret"  com- 
position. Four  months  later  he  comes  to  consult  me, 
and  I  observe  the  following  accidents  upon  him  :  papular 
syphilide  covering  the  thorax  and  the  limbs ;  tonsillar 
syphilides ;  crusts  of  the  hairy  scalj) ;  alopecia ;  cervical 
adenopathies. 

Mercurial  treatment.  Disapi^earance  of  the  accidents 
in  a  few  weeks. 

Afterward  recurrence  of  a  papulo-squamous  syphilide, 
affecting  the  scrotum.  Mercurial  treatment  is  resumed ; 
later,  iodide  of  potassium. 

The  patient  is  treated  regularly  during  five  or  six 
months,  after  which  I  lose  sight  of  him.     I  have  since 


NOTES  AND  ILLUSTRATIVE  GASES.  241 

learned  from  him  that,  believing  himself  cured,  he  no 
longer  followed  any  medication  after  this  time. 

Two  years  after  the  debut  of  his  syphilis,  he  marries, 
without  taking  counsel  of  me  or  of  any  other  physician. 
He  was,  nevertheless,  far  from  being  cured  at  this  time, 
as  was  demonstrated  by  the  reappearance  of  various  acci- 
dents in  the  following  years  :  cutaneous  syphilides,  buccal 
erosions,  onyxis,  periostosis,  etc. 

II.  Some   months   after   his   marriage,    the  wife  of 

N commenced  to  complain  of  neuralgias  of  the  head, 

of  intense  pains  in  the  limbs,  of  insomnia,  of  general 
malaise,  of  febrile  attacks,  etc.  These  various  symptoms 
were  at  first  treated  with  the  sulphate  of  quinine,  but 
without  success.  Soon  a  confluent  eruption  covered  the 
body,  and  enlightened  the  physician  as  to  the  nature  of 
the  anterior  accidents  which  had,  until  then,  resisted  his 
medication. 

At  this  time  this  woman  was  brought  to  me,  and  I  noted 
upon  her  accidents  of  a  nature  incontestably  syphilitic : 
generalized  papulo-squamous  syphilide,  palmar  psoriasis, 
crusts  of  the  hairy  scalp,  with  scattered  alopecia,  tonsillar 
erosions,  cervical  adenopathies,  etc.  In  addition,  about 
this  same  date,  she  became  pregnant. 

Mercurial  treatment :  rapid  disappearance  of  the  acci- 
dents ;  accouchement,  at  term,  of  a  fine  child,  which,  con- 
trary to  my  express  recommendations,  was  committed  to  a 
nurse  at  some  distance  from  the  citj. 

III.  I  had  lost  sight  of  these  two  patients  for  a  cer- 
tain time,  when,  one  day,  1^ summoned  me  to  his 

house,  to  present  to  me  at  the  same  time — 1.  His 
diseased  infant ;  2.  The  nurse  of  this  infant  infected  by 
it ;  3.  The  husband  of  this  nurse  infected  by  his  ^ife. 
And,  in  fact,  a  long  interrogation,  followed  by  a  care- 


242  SYPHILIS  AND  MAREIAOE. 

fill  examination  revealed  to  me  the  following  series  of 
results : 

1.  The  infant  remained  exemj)t  from  every  morbid 
symptom  during  the  first  four  or  five  weeks.  After  that 
time  its  body  was  covered  with  pimples,  especially  around 
the  buttocks,  its  mouth  was  ulcerated,  its  nose  "  ran  pro- 
fusely." It  became  thin,  emaciated,  and  they  had  fears 
for  its  life  during  several  months.  Nevertheless,  it  grew 
better,  thanks  to  the  treatment  which  was  prescribed  for 
it  by  the  physician  of  the  locality  (mercurial  frictions, 
baths  of  the  sublimate,  iodide  of  potassium,  etc.).  It 
now  presents  various  specific  accidents  :  erosive  syphilides 
at  the  buccal  commissures  ;  papulo-ulcerous  syphilides  of 
the  margin  of  the  anus,  etc. 

2.  Some  weeks  after  the  invasion  of  these  accidents 
upon  the  nursling,  the  nurse's  breast  became  "ulcerated." 
She  was  not  told  the  nature  of  the  lesion  on  her  bosom, 
but  she  says  that  she  was  treated  with  mercurial  pills  at 
this  time.  Besides,  some  weeks  later,  she  suffered  from 
sore-throat  and  an  inflammation  of  the  vulva,  with  "ex- 
coriated pimples  "  ;  her  body  was  covered  -with  a  red  erup- 
tion, and  her  hair  fell  out  to  such  an  extent  that  she 
"thought  she  would  become  absolutely  bald."  I  observed 
upon  her,  at  the  time  of  my  visit,  undoubted  traces  of  a 
squamous  syphilide,  cervical  adenopathies,  a  severe  alo- 
pecia, and  pigmentary  macules  scattered  upon  the  neck. 

3.  The  infant  of  this  woman  (which  she  nursed  at  the 

same  time  as  the  infant  of  N )  had  been  healthy  from 

its  birth,  and  it  had  continued  to  "thrive"  during  several 
weeks.  But  two  months  ago  it  suddenly  commenced  to 
waste  away.  Its  body  became  covered  with  a  papular 
erux)tion,  its  mouth  became  ulcerated,  its  legs  became 
swollen ;  it  then  died  in  a  state  of  consumption.     The  at- 


NOTES  AND  ILLUSTRATIVE  OASES  243 

tending  physician,  I  was  informed,  had  no  doubt  that  the 
child  succumbed  to  a  syphilis  contracted  after  its  birth. 

4.  Finally,  the  husband  of  this  woman,  a  man  of  regu- 
lar habits  and  of  irreproachable  morality,  became  diseased 
some  months  after  his  wife.  He  commenced  by  i^resent- 
ing  several  ^^'boidons^''  upon  the  penis,  then  he  was  af- 
fected with  a  confluent  eruption,  with  pains  in  the  head, 
with  sore-throat,  etc.  I  found  him,  at  the  time  he  came 
under  my  observation,  in  an  active  condition  of  secondary 
syphilis  :  erythemato-papular  syphilide,  eruption  of  crusts 
of  the  hairy  scalp,  cervical  adenopathies,  buccal  syphilides, 
etc.  In  addition,  I  found,  on  the  glando-preputial  furrow, 
two  cicatricial  indurations  with  a  double  inguinal  pleiad, 
which  were  unquestionably  the  remains  of  the  primitive 
infection. 

To  recapitulate,  then : 

1.  Premature  marriage  of  a  syphilitic  subject. 

2.  Contagion  transmitted  from  the  husband  to  his  wife. 

3.  Birth  of  a  syphilitic  child,  which  is  committed  to  a 
nurse,  in  defiance  of  medical  advice. 

4.  Contagion  transmitted  by  this  child  to  its  nurse. 

5.  Contagion  transmitted  by  this  nurse  to  her  own 
child,  which  becomes  emaciated,  wastes  away,  and  dies. 

6.  Contagion  transmitted  by  this  same  nurse  to  her 
husband. 

That  is  to  say,  five  cases  of  syphilis  and  one  death 
resulting  from  the  premature  marriage  of  a  man  mth  a 
syphilis  not  yet  extinct. 


NOTE  VI. 

FATHER  SYPHILITIC .;  CHILD  SYPHILITIC  ;  MOTHER  SEEM- 
ING AT  FIRST  EXEMPT,  BUT  PRESENTING,  SIX  YEARS 
LATER,    AN   ACCIDENT   OF   TERTIARY   SYPHILIS. 

"  In  186-  I  had  under  my  care  Madame  Z during 

the  last  six  months  of  her  pregnancy,  which,  moreover, 
was  complicated  with  frequent  nausea  and  occasional 
vomiting.  The  6th  of  April  this  woman  gave  birth  to  a 
little  gui,  well  developed,  healthy  in  appearance,  weighing 
three  kilogrammes  one  hundred  and  fifty-two  grammes. 
The  delivery  was  completed  naturally,  twenty  minutes 
after  the  accouchement.  The  placenta  was  healthy.  The 
after-results  of  the  accouchement  were  favorable. 

"About  the  tenth  day  the  child  had  a  little  fever, 
green  stools,  erythema  of  the  buttocks.  On  the  fifteenth 
day  an  eruption  showed  itself  on  different  portions  of  the 
surface.  It  soon  took  on  the  characteristics  of  a  syph- 
ilitic ecthyma.  The  15th  of  May,  mucous  patches,  as 
manifest  and  as  typical  as  possible,  appeared  around  the 
anus  and  on  the  vulva.  A  treatment,  consisting  of  baths 
of  the  sublimate  and  frictions  with  mercurial  ointment, 
soon  caused  the  disappearance  of  these  various  accidents. 

"Nevertheless,  the  mother  continued,  and  has  since 
continued,  to  nurse  her  child.  She  has  not  ceased  to  be 
perfectly  weU,  and,  notably,  she  has  never  presented  any 
symptom  which  could  be  attributed  to  syphilis.     I  will 


NOTES  AND  ILLUSTRATIVE  CASES.  245 

add  that  a  careful  interrogatory,  as  minute  as  possible, 
into  tlie  antecedents  of  this  woman  did  not  enable  me  to 
discover  anything  specific  in  her  history.  When  she 
ceased  nursing  her  "infant  (fourteen  months  later),  she  was 
a  little  anaemic,  and  complained  of  a  persistent  pain  be- 
tween the  shoulders.  She  improved  rapidly,  and  without 
any  medication,  as  soon  as  she  ceased  nursing. 

"  The  father,  interrogated  by  me  as  to  his  antecedents, 
had  confessed  to  me  that  he  had  contracted  an  infecting 
chancre  four  months  before  his  marriage,  and  that  even  at 
the  moment  of  conception  he  was  still  affected  with  vari- 
ous secondary  accidents  (mucous  patches  at  the  anus, 
mucous  patches  on  the  tonsils,  and  disseminated  crusts  of 
the  hairy  scalp). 

"  I  found  myself  in  the  presence  then — 1.  Of  a  syph- 
ilitic father,  still  presenting  syphilitic  accidents  at  the 
moment  of  the  conception  of  his  child.  2.  Of  a  syphilitic 
child  commencing  to  present  undoubted  manifestations 
of  syphilis  on  the  fifteenth  day  after  its  birth.  3.  Of  a 
mother  not  infected,  and  appearing  to  have  never  suf- 
fered any  specific  accident  before  her  accouchement, 
and  having  nursed  her  syphilitic  infant  during  fourteen 
months  without  contracting  the  least  contagious  symp- 
tom from  it. 

"  This  fact  overturned  all  my  beliefs  upon  syphilitic 
heredity,  and  notably  my  cardinal  conviction,  viz.,  that, 
if  a  child  be  born  tainted  with  syphilis,  the  mother  must 
certainly  have  been  infected.  In  my  opinion,  as  I  had 
established  in  a  previous  memoir,  pas  de  syphilis  de  V en- 
fant sans  syphilis  de  la  mere. 

"During  six  years,  I  was  privileged  to  look  after  the 
health  of  this  family,  and  I  can  testify  that — 1.  The  child, 

submitted  to  the  above-mentioned  treatment,  has  survived. 

17 


246  ,  SYPHILIS  AND  MARRIAGE. 

Although  somewhat  lymphatic,  it  has  never  ceased  to  en- 
joy very  good  health.  2.  The  father,  vv^ho  has  followed  a 
rigorous  and  prolonged  treatment,  has  presented  no  more 
specific  manifestations.  3.  The  mother,  scrupulously  ob- 
served, has  not  ceased  to  continue  well,  apart  from  certain 
passing  indispositions. 

"  I  confess  that  this  case  (followed  up  by  me  from  day 
to  day,  so  to  speak)  very  much  disturbed  my  former  con- 
victions.    I  was  even  preparing  to  publish  it,  when,  in  the 

month  of  October,  188-,  Madame  Z came  to  consult 

me  in  regard  to  a  tumor  on  her  right  arm.  This  tumor, 
situated  beneath  the  skin,  immediately  above  the  olecranon, 
was  of  the  volume  of  a  pigeon's  e^g.  Its  circumference 
and  base  were  hard,  but  its  central  portion  was  soft.  It 
had  never  given  rise  to  pain,  and  it  still  remained  indo- 
lent, even  on  palpation  and  pressure.  The  integument 
around  the  portion  in  process  of  softening  presented  a 
brownish-red  color.  I  examined  this  tumor  A\ith  great 
care,  and  I  arrived  at  the  conclusion  that  it  could  only  be 
constituted  by  a  sypMlitic  gumma.  Ten  days  later,  an 
abscess  formed  in  the  tumor,  and  opened  at  its  central 
portion.  It  gave  exit  to  a  liquid  which  was  composed  of 
tv/o  distinct  portions,  one  transparent  and  gelatinous,  simi- 
lar to  dissolved  gum,  the  other  purulent.  The  tumor  once 
opened,  I  perceived  that  the  base  of  the  abscess  was  gray- 
ish, as  if  putrilaginous.  The  opening  rapidly  enlarged, 
presenting  a  sinuous  contour,  with  borders  neatly  and  per- 
pendicularly cut.  The  base  of  the  tumor  stUl  remained 
indurated.  These  characteristics,  this  evolution,  tended 
to  confirm  me  in  my  first  impression.  I  diagnosticated  a 
gummous  tumor,  and  I  do  not  indeed  believe  that  any 
other  diagnosis  could  have  been  arrived  at. 

''Treatment  by  iodide  of  potassium,  doses  at  first  in- 


NOTES  AND  ILLUSTRATIVE  GASES.  247 

creasing,  then  decreasing ;  rapid  improvement  of  the  le- 
sion ;  cnre  in  less  than  three  weeks. 

"The  evidence  was,  then,  conclusive.  Besides,  what 
other  diseases  could  this  tumor  be  confounded  with  ?  With 
an  anthrax  ?  With  an  abscess  ?  But  the  absence  of  pain, 
the  absence  of  inflammatory  phenomena,  the  objective 
aspect  of  the  lesion,  the  morbid  evolution,  all  exclude 
such  hypotheses ;  and,  more,  the  rapid  cure  effected  by 
the  iodide  of  potassium  completely  demonstrates,  at  least 
in  my  opinion,  that  it  was  a  lesion  of  tertiary  syphilis. 

"It  is  certain,  then,  that  Madame  Z had  been  in- 
fected at  some  previous  date,  either  before  or  during  her 
pregnancy.  Her  syphilis  had  been  obscure,  fugacious. 
This  syphilis  had  passed  unrecognized  both  by  the  patient 
and  myself.  Finally,  it  did  not  reveal  itself  in  a  manifest 
shape  until  six  years  later,  by  the  outbreak,  quite  unex- 
pected, of  a  lesion  of  the  tertiary  order. 

"Altogether,  this  case,  which  at  first  seemed  as  if  it 
must  of  necessity  overturn  the  theory  which  I  for  a  long 
time  had  sustained  (in  accord  with  that  of  M.  CuUerier, 
M.  Notta,  and  other  observers),  viz.,  that  eTiery  syphilitic 
child  is  horn  from  a  syphilitic  mother — this  case,  I  say, 
has,  on  the  contrary,  furnished  an  additional  argument 
for  the  theory  in  question,  and  confirms  it  absolutely." — 
(Dr.  A.  Charrier.) 


NOTE  VII. 

INAPTITUDE  FOR  LIFE,   AS  AIST  HEREDITARY  CONSEQUENCE 
OF  PATERNAL   SYPHILIS. 

A  CARDINAL  fact  Wiiicli  I  have  endeavored  to  place  in 
strong  relief  in  tliis  work  relates  to  tlie  most  serious  of  tlie 
hereditary  consequences  of  paternal  syphilis. 

I  have  asserted,  and  I  think  demonstrated,  that  the 
child  procreated  by  a  syphilitic  father  is  very  often 
stamped  with  a  sort  of  inaptitude  for  life.  In  other 
words,  this  child  is  liable  to  die  early,  either  in  utero,  or 
within  a  short  time  after  accouchement. 

I  can  not  reproduce  here  all  the  facts  which  have 
served  to  establish  my  conviction  upon  this  point ;  but  I 
think  that  I  ought  to  place  a  certain  number  under  the 
eyes  of  the  reader  as  illustrative  cases  : 

Case  I. — Indui-ated  chancre  of  the  penis  ;  roseola  ;  palmar 
psoriasis ;  tonsillar  syphilides ;  treatment  from  six  to  eight 
months,  but  irregularly  followed  ;  marriage  five  years  after  the 
d6but  of  the  syphilis  ;  wife  perfectly  healthy,  remaining  abso- 
lutely exemjDt  ;  four  pregnancies  ;  four  abortions  ;  *  at  this  time 

*  I  specify,  once  for  all,  that  in  this  case,  as  in  the  following  cases,  abortion  or 
premature  accouchement  could  not  possibly  have  been  due  to  any  cause,  either 
accidental  or  constitutional,  depending  upon  the  wife.  We  have  here  to  deal  only 
with  cases  (I  have  selected  them  designedly)  where  after  careful  examination, 
after  searching  for  and  excluding  every  other  cause,  the  death  of  the  foetus  re- 
mains exclusively  imputable  to  the  syphilis  of  the  husband. 


NOTES  AND  ILLUSTRATIVE  CASES.  249 

the  patient  is  subjected  to  a  new  treatment  (mercury  and  iodide 
of  potassium  for  about  a  year)  ;  four  pregnancies  afterward  ; 
four  accouchements  at  term  ;  children  living  and  healthy  (the 
eldest  is  at  present  twelve  years  old). 

Case  II. — Indurated  chancre  ;  buccal  syphilides  ;  insignificant 
treatment  of  a  few  weeks'  duration  ;  married  fifteen  months  after 
debut  of  syphilis  ;  wife  remaining  absolutely  exempt ;  nine  preg- 
nancies ;  five  abortions  ;  three  accouchements  before  term,  infants 
living  from  a  few  hours  to  three  days  ;  ninth  pregnancy  at  term, 
resulting  in  a  living  infant,  which,  fifteen  days  later,  was  covered 
with  syphilides. 

Case  III. — Indurated  chancre,  followed  by  some  secondary 
accidents  ;  treatment  from  six  to  eight  months  ;  ocular  paralysis 
three  years  later  ;  marriage  seven  years  after  the  debut  of  the 
syphilis  ;  tertiary  accident  (exostosis)  the  same  year ;  treatment 
resumed  with  vigor,  wife  remaining  exempt ;  four  pregnancies 
from  year  to  year  ;  first  pregnancy  terminated  by  abortion  ;  sec- 
ond pregnancy  :  accouchement  at  eight  months  of  a  dead  infant  ; 
third  pregnancy  :  accouchement  at  term,  infant  dying  in  a  few 
hours  ;  fourth  pregnancy  :  accouchement  at  term,  child  surviving 
and  healthy. 

Case  IV. — Indurated  chancre  ;  cutaneous  and  mucous  syphi- 
lides ;  treatment  for  about  a  year ;  marriage  four  years  later  ; 
the  first  pregnancy  is  terminated  by  an  accouchement  at  term  ; 
child  living  and  healthy  ;  two  years  later,  reawakening  of  the  di- 
athesis ;  tuberculo-ulcerative  syphilide,  rebellious  and  recurring ; 
sclerous  glossitis  ;  gumma  ;  ecthyma ;  this  crop  of  accidents  is 
prolonged  during  three  years,  despite  an  energetic  treatment  ;  it 
coincides  with  three  pregnancies  which  all  terminate  in  abortion  ; 
wife  uncontaminated. 

Case  V. — Indurated  chancre,  followed  by  a  few  very  slight 
secondary  accidents  ;  mercurial  treatment  during  two  months  ;  the 
following  years,  small  doses  of  iodide  of  potassium  from  time  to 
time ;  marriage  fourteen  years  after  debut  of  syphilis,  wife  re- 


250  SYPHILIS  AND  MARRIAGE. 

maining  uninfected  ;  two  pregnancies  in  the  course  of  the  two 
years  succeeding  marriage  ;  the  first  terminating  by  accouchement 
at  term  of  a  dead  infant ;  the  second  producing  a  syphilitic  infant, 
which  dies  in  three  weeks  ;  consecutively,  husband  has  recurrence 
of  tertiary  accidents. 

Case  VI. — Syphilis ;  indurated  chancre  of  the  penis  ;  two  to 
three  months  mercurial  treatment  in  feeble  doses  ;  no  secondary 
accidents  remarked  ;  marriage  four  years  later,  wife  remaining 
exempt ;  three  jiregnancies  terminated  by  three  abortions  ;  at  this 
time  accidents  of  tertiary  form  ;  treatment  energetic,  and  pro- 
longed w^ith  mercury  and  the  iodide  of  potassium  ;  a  fourth  preg- 
nancy happening  a  year  later  results  in  a  child  at  term,  living  and 
healthy. 

Case  VII. — Indurated  chancre  of  the  prepuce  ;  confluent  rose- 
ola ;  mercurial  treatment  for  several  months  ;  afterward  lingual 
syphilides  ;  marriage  five  years  after  the  debut  of  the  disease  ; 
wife  uninfected  ;  three  pregnancies  terminating  in  the  following 
manner  :  one  abortion  ;  two  accouchements  before  term,  infants 
dead  ;  consecutively,  the  husband  affected  with  a  psoriasiform 
syphilide. 

Case  VIII. — Chancre  of  the  lip  ;  cutaneous  syphilides  ;  buccal 
patches  ;  onyxis,  mercurial  treatment  for  several  months  ;  mar- 
riage one  year  later,  wife  remaining  exempt  ;  three  pregnancies 
in  three  years  ;  the  first  two  infants  still-born  ;  the  third  is  born 
syphilitic,  and  dies  in  three  months  ;  consecutively  the  husband 
affected  with  a  psoriasiform  syphilide  of  the  hands. 

Case  IX. — Indurated  chancre  ;  secondary  accidents  ;  mercu- 
rial treatment  of  one  month  only  ;  marriage  two  years  later,  wife 
remaining  exempt ;  two  pregnancies  terminate  by  abortion  ;  third 
pregnancy,  infant  at  term,  cachectic,  dying  in  a  few  weeks  ;  after- 
ward husband  is  reattacked  with  ulcerative  syphilides  of  the  penis. 

Cask  X.— Labial  chancre  ;  roseola  ;  tonsillar  syphilides  ;  mer- 
curial treatment  of  three  months  ;  marriage  ten  years  later,  wife 
remaining  exempt ;  four  pregnancies  ;  two  abortions  ;  tAvo  infants 


NOTES  AND  ILLUSTRATIVE  CASES  251 

born  at  term,  hydrocephalic,  soon  dying  ;  consecutively  the  pa- 
tient is  affected  with  cranial  osteitis  ;  symptomatic  encephalitis  ; 
death. 

Case  XL — Indurated  chancre  of  the  prepuce  ;  papular  syphi- 
lide  ;  buccal  syphilides  ;  onyxis  ;  cervical  adenopathies  ;  tibial 
periostosis  ;  treatment  of  six  months  ;  marriage  three  years  later, 
wife  remaining  exempt ;  four  pregnancies  ;  the  first  two  termi- 
nate by  abortion  ;  the  third  brings  a  syphilitic  infant  to  term, 
which  dies  the  second  day  ;  resumption  of  treatment ;  fourth  preg- 
nancy :  child  syphilitic,  surviving. 

Case  XII. — Indurated  chancre  of  the  sheath  ;  roseola  ;  anal 
and  buccal  syphilides  ;  treatment  of  four  weeks  by  mercury,  then 
treatment  of  two  months  with  iodide  of  potassium  ;  marriage  in 
the  second  year  of  the  disease,  wife  remaining  exempt ;  two  mis- 
carriages ;  third  pregnancy,  giving  a  syphilitic  infant  (syphilides, 
pemphigus,  osseous  lesions),  which  soon  dies. 

XIII. — Indurated  chancre  ;  secondary  syphilides  of  the  skin 
and  mucous  membranes  ;  iritis  ;  treatment  for  some  months  ;  mar- 
riage two  years  later,  wife  remaining  uninfected  ;  four  pregnan- 
cies, three  quite  near  each  other  ;  the  first  two  terminate  by 
abortion  ;  the  third  gives  a  syphilitic  infant,  which  survives, 
thanks  to  an  energetic  treatment  ;  the  fourth  produces  an  infant 
which  has  never  to  this  day  presented  specific  accidents. 

XIV. — Indurated  chancre  ;  some  secondary  accidents  ;  treat- 
ment for  several  months  ;  marriage  four  years  later  ;  wife  remain- 
ing exempt ;  two  abortions  ;  third  infant  syphilitic,  dying  when 
four  weeks  old. 


THE   END, 


provided  Uy  "^  ^_==r======* 

the  Ubranan  m  en**  &  .^^=====r 


C28(»46>M'°° 


V^t.i\^ 


